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
- 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.
- Gastric Feeding Group: 58.1±15.4 years
- SB Feeding Group: 59.6±15.3 years.
- Illness severity not described
- 20-bed MICU.
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)||
|Frequency of GRV>200ml (percentage)||
Time from Initial Placement until Feeding Started (hours)
Time to Reach Goal from Initial Tube Placement (hours)
|Clinically Significant Aspiration||
- 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
|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|
|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|