CI: Monitoring Criteria: Gastric Residual Volume (2006)
Neumann DA, DeLegge MH. Gastric vs small bowel tube feeding in the intensive care unit: A prospective comparison of efficacy. Crit Med 2002; 30: 1,436-1,438.
PubMed ID: 12130958
To compare the outcomes of intensive care unit patients fed through a masogastric (ng) vs. nasal-small bowel (SB) including the time from tube placement to feeding, time to reach goal rate and adverse events.
- Medical ICU patients
- Need enteral feeding.
- Gastrointestinal obstruction
- Iileus
- Pancreatitis
- Gastroparesis
- No consent.
- Recruitment: MICU patients who met inclusion criteria
- Design: RCT; prospective randomization by computer-generated, individually-numbered and sealed envelopes
- Blinding: Not blinded.
- Gastric or small bowel feeding tube
- All feeds started at 30ml per hour and advanced 10ml per hour every seven hours until reaching goal rate
- Feedings were held for GRV over 200ml.
- Wilcoxon's rank sum analysis
- P<0.05 was considered significant.
Timing and Method of Measurements
- Times recorded in hours from successful tube insertion, onset of feeding, achievement of goal rate and termination of feeding
- 60-ml syringe used to measure GRV (but no time specified as to frequency of measure).
- Number of attempts to place feeding tube
- Frequency of GRV above 200ml
- Time until feeding started from initial placement (hours)
- Time to reach goal from successful tube placement (hours)
- Clinically-significant aspiration [new infiltrate on chest radiograph subsequently treated with antibiotics against oral flora or suctioning of tube feeding formula (had blue dye) from oral pharynx or airway].
Independent Variables (Intervention or Procedure)
Gastric or SB feeding tube.
Initial N (Percentage Male)
- 60 (50% male)
- N=30 (50% male) for both gastric and SB feeding groups.
- P=0.719
- Gastric Feeding Group: 58.1±15.4 years
- SB Feeding Group: 59.6±15.3 years.
Ethnicity
Not described.
- Illness severity not described
- 20-bed MICU.
Key Findings
Gastric feeding is not higher in adverse effects than SB feeding: The feeding tube can be placed more quickly and feeding goals reached sooner.
Outcomes of Gastric vs. Small Bowel Feeding
Outcome | Gastric (N=30) | SB (N=30) | Statistical Significance |
Attempts to Place Feeding Tube (median) |
1.1±0.3
|
1.9±0.7
|
P<0.001 |
Frequency of GRV>200ml (percentage) |
13.3% |
20%
|
P=0.488 |
Time from Initial Placement until Feeding Started (hours) |
11.2±11.0
|
27.0±22.6
|
P<0.001 |
Time to Reach Goal from Initial Tube Placement (hours) |
28.8±15.9
|
43.0±24.1
|
P=0.024 |
Clinically Significant Aspiration |
0/30 (0%)
|
1/30 (3.3%)
|
P=1.00 |
- No data for mortality, incidence of pneumonia, LOS, days on mechanical ventilation or cost of care
- No significant difference in adverse events.
- No difference in aspiration or other adverse outcomes in gastric vs. SB feedings
- Gastric feeds can be started faster and NG feeds offer safe and efficient means of enteral nutrition in the majority of medical ICU patients.
University/Hospital: | Allegheny General Hospital, Medical University of South Carolina |
No power analysis.
Quality Criteria Checklist: Primary Research
|
|||
Relevance Questions | |||
1. | Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) | Yes | |
2. | Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? | Yes | |
3. | Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? | Yes | |
4. | Is the intervention or procedure feasible? (NA for some epidemiological studies) | Yes | |
Validity Questions | |||
1. | Was the research question clearly stated? | Yes | |
1.1. | Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? | Yes | |
1.2. | Was (were) the outcome(s) [dependent variable(s)] clearly indicated? | Yes | |
1.3. | Were the target population and setting specified? | Yes | |
2. | Was the selection of study subjects/patients free from bias? | Yes | |
2.1. | Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? | Yes | |
2.2. | Were criteria applied equally to all study groups? | Yes | |
2.3. | Were health, demographics, and other characteristics of subjects described? | Yes | |
2.4. | Were the subjects/patients a representative sample of the relevant population? | Yes | |
3. | Were study groups comparable? | Yes | |
3.1. | Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) | Yes | |
3.2. | Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? | Yes | |
3.3. | Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) | Yes | |
3.4. | If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? | N/A | |
3.5. | If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) | N/A | |
3.6. | If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? | N/A | |
4. | Was method of handling withdrawals described? | Yes | |
4.1. | Were follow-up methods described and the same for all groups? | Yes | |
4.2. | Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) | Yes | |
4.3. | Were all enrolled subjects/patients (in the original sample) accounted for? | Yes | |
4.4. | Were reasons for withdrawals similar across groups? | N/A | |
4.5. | If diagnostic test, was decision to perform reference test not dependent on results of test under study? | N/A | |
5. | Was blinding used to prevent introduction of bias? | No | |
5.1. | In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? | N/A | |
5.2. | Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) | Yes | |
5.3. | In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? | N/A | |
5.4. | In case control study, was case definition explicit and case ascertainment not influenced by exposure status? | N/A | |
5.5. | In diagnostic study, were test results blinded to patient history and other test results? | N/A | |
6. | Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? | Yes | |
6.1. | In RCT or other intervention trial, were protocols described for all regimens studied? | Yes | |
6.2. | In observational study, were interventions, study settings, and clinicians/provider described? | N/A | |
6.3. | Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? | Yes | |
6.4. | Was the amount of exposure and, if relevant, subject/patient compliance measured? | Yes | |
6.5. | Were co-interventions (e.g., ancillary treatments, other therapies) described? | Yes | |
6.6. | Were extra or unplanned treatments described? | N/A | |
6.7. | Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? | Yes | |
6.8. | In diagnostic study, were details of test administration and replication sufficient? | N/A | |
7. | Were outcomes clearly defined and the measurements valid and reliable? | Yes | |
7.1. | Were primary and secondary endpoints described and relevant to the question? | Yes | |
7.2. | Were nutrition measures appropriate to question and outcomes of concern? | Yes | |
7.3. | Was the period of follow-up long enough for important outcome(s) to occur? | Yes | |
7.4. | Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? | Yes | |
7.5. | Was the measurement of effect at an appropriate level of precision? | Yes | |
7.6. | Were other factors accounted for (measured) that could affect outcomes? | N/A | |
7.7. | Were the measurements conducted consistently across groups? | N/A | |
8. | Was the statistical analysis appropriate for the study design and type of outcome indicators? | ??? | |
8.1. | Were statistical analyses adequately described and the results reported appropriately? | ??? | |
8.2. | Were correct statistical tests used and assumptions of test not violated? | ??? | |
8.3. | Were statistics reported with levels of significance and/or confidence intervals? | N/A | |
8.4. | Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? | Yes | |
8.5. | Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? | N/A | |
8.6. | Was clinical significance as well as statistical significance reported? | Yes | |
8.7. | If negative findings, was a power calculation reported to address type 2 error? | No | |
9. | Are conclusions supported by results with biases and limitations taken into consideration? | Yes | |
9.1. | Is there a discussion of findings? | Yes | |
9.2. | Are biases and study limitations identified and discussed? | Yes | |
10. | Is bias due to study's funding or sponsorship unlikely? | Yes | |
10.1. | Were sources of funding and investigators' affiliations described? | Yes | |
10.2. | Was the study free from apparent conflict of interest? | Yes | |