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CI: Gastric vs. Small Bowel Feeding Tube Placement (2006)


Heyland DK, Drover JW, Dhaliwal R, Greenwood J. Optimizing the benefits and minimizing the risks of enteral nutrition in the critically ill: Role of small bowel feeding. JPEN 2002; 26 (6): S51-S57.

PubMed ID: 12405623
Study Design:
Meta-analysis or Systematic Review
M - Click here for explanation of classification scheme.
Quality Rating:
Positive POSITIVE: See Quality Criteria Checklist below.
Research Purpose:

To systematically review and statistically aggregate studies that compare gastric vs. small bowel feedings (reported outcomes for ventilator-assisted pneumonia and mortality).

Inclusion Criteria:
  • Randomized Clinical Trial
  • Critically ill
  • Small bowel vs. gastric feeding.
Exclusion Criteria:

Pseudorandomized studies

Description of Study Protocol:
  • Literature search
  • Assessment method
  • Analyze primary end-points of mortality, pneumonia
  • Analyze secondary end-points of nutritional adequacy.
Data Collection Summary:
  • Primary end-point prevalence
  • Percent energy needs
  • Percent energy, nitrogen needs.
Description of Actual Data Sample:

10 RCTs with a total of 612 patients

Summary of Results:
  • Meta-analysis of nine trials showed NS difference in mortality RR 0.93 (95% CI 0.72-1.20); no trial adequately powered to detect difference in mortality
  • Meta-analysis of seven studies showed significantly less ventilator associated pneumonia RR 0.76 (95% CI 0.59-0.99)
  • Small bowel feeding reduces gastroesophageal reflux.
Author Conclusion:

Small bowel feeding may be associated with a reduction in gastroesophageal regurgitation, an increase in nutrient delivery, shorter time to target nutritional goal, and lower rate of ventilator-associated pneumonia.

Funding Source:
Government: Ontario Ministry of Health
Reviewer Comments:

RCTs included in meta-analysis: Taylor et al, 1999; Heyland et al, 2001; Esparaza et al, 2001; Bolvin and Levy, 2001; Kortbeek et al, 1999; Montecalvo et al, 1992; Daview 35 al, 2002; Montejo et al, 2002; Minard et al, 2000 and Kearns et al, 2000.

Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? Yes
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? Yes
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? Yes
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? Yes
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes