CI: Gastric vs. Small Bowel Feeding (2011)
Citation:
Marik PE, Zaloga GP. Gastric versus post-pyloric feeding: A systematic review. Crit Care. 2003; 7: 46-51.
PubMed ID: 12793890Study Design:
Meta-analysis or Systematic Review
Class:
M - Click here for explanation of classification scheme.
Quality Rating:
POSITIVE: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- Unpublished data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 | |