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
To evaluate the impact of gastric vs. post-pyloric feeding on the incidence of pneumonia, caloric intake, ICU LOS and mortality in ICU patients.
PRCT in medical, neurosurgical or trauma ICU patients.
- Unpublished data
- Personal communications
- 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.
- Incidence pneumonia
- Percentage kcal intake
- Time to start feeds
- Time to goal feeds
- ICU LOS.
- 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).
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.
- 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.
|University/Hospital:||University of Pittsburgh, Department of Medicine of Indiana University School of Medicine,|
No power analysis given at all.
Quality Criteria Checklist: Review Articles
|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|
|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|