CI: Gastric vs. Small Bowel Feeding (2011)


Marik PE, Zaloga GP. Gastric versus post-pyloric feeding: A systematic review. Crit Care. 2003; 7: 46-51.

PubMed ID: 12793890
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 evaluate the impact of gastric vs. post-pyloric feeding on the incidence of pneumonia, caloric intake, ICU LOS and mortality in ICU patients.

Inclusion Criteria:

PRCT in medical, neurosurgical or trauma ICU patients.

Exclusion Criteria:
  • Unpublished data
  • Personal communications
  • Abstracts.
Description of Study Protocol:
  • Two investigators abstracted PRCT reports independently
  • Pneumonia and mortality were binary variables
  • Percentage of kcal intake, time to start feeds, time to goal and ICU LOS were continuous
  • Used random effects model.
Data Collection Summary:
  • Incidence pneumonia
  • Mortality
  • Percentage kcal intake
  • Time to start feeds
  • Time to goal feeds
  • ICU LOS.
Description of Actual Data Sample:
  • Screened 122 articles, 14 accepted
  • Five more excluded due to endpoints not recorded or not ICU patients
  • Total nine studies, 522 patients comparing gastric (G) vs. post-pyloric (PP).
Summary of Results:

Key Findings

G vs. post-pyloric:

  • No difference in incidence pneumonia: 1.44, 0.84 to 2.46
  • No difference in percentage kcal achieved: -5.2%, -18% to +7.5%
  • No difference in ICU LOS: -1.4, -3.7 to +0.85 days
  • Shorter time to start feeds in G: -16 hours -19.5 to -12.6 hours, P<0.00001
  • Time to goal intake not different (-0.78 hour, -3.78 to +2.19 hours) for G vs. PP.
Author Conclusion:
  • We were unable to demonstrate a clinical benefit from PP vs G tube feeding in a mixed group of ICU patients. Incidences of pneumonia, ICU LOS and mortality were similar. G feeds were initiated sooner than PP.
  • Findings were limited by small total sample size.
Funding Source:
University/Hospital: University of Pittsburgh, Department of Medicine of Indiana University School of Medicine,
Reviewer Comments:

No power analysis given at all.

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? No
  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? No