Nutritional outcome and pneumonia in critical care patients randomized to gastric versus jejunal tube feedings. The Critical Care Research Team.
OBJECTIVE
To compare nutritional status, gastric colonization, and rates of nosocomial pneumonia in ICU patients randomized to gastric tube feeding vs. patients fed by an endoscopically placed jejunal tube.


METHODS
Randomized, prospective study.


METHODS
Medical and surgical ICUs at Boston City Hospital; surgical ICU at University Hospital.


METHODS
Of the 38 study patients, 19 were randomized to gastric tube feeding and 19 were randomized to an endoscopically placed jejunal tube. The two groups were similar in age, sex, race, underlying disease, and type of surgery.


RESULTS
The two patient groups were similar in number of days fed, duration of ICU stay, duration of mechanical ventilation, days of antibiotic therapy, and days with fever. Compared with the gastric group, the jejunal group had more patients with circulatory shock on admission (79% vs. 68.4%), higher admission Acute Physiology Score (24.0 vs. 21.7), and fewer patients with pneumonia at randomization (26.3% vs. 31.6%). The jejunal group received a significantly higher percentage of their daily goal caloric intake (p = .05), and had greater increases in serum prealbumin concentrations (p < .05) than the patients with gastric tube feeding. Although the jejunal tube group had more days of diarrhea (3.3 +/- 6.6 vs. 1.8 +/- 2.9), this difference was not statistically significant. Nosocomial pneumonia was diagnosed clinically in two (10.5%) patients in the gastric tube group and in no patients in the jejunal tube group.


CONCLUSIONS
Patients fed by jejunal tube received a significantly higher proportion of their daily goal caloric intake, had a significantly greater increase in serum prealbumin concentrations, and had a lower rate of pneumonia than patients fed by continuous gastric tube feeding.
Montecalvo
M A
MA
Department of Medicine, Boston University School of Medicine, MA.
Steger
K A
KA
Farber
H W
HW
Smith
B F
BF
Dennis
R C
RC
Fitzpatrick
G F
GF
Pollack
S D
SD
Korsberg
T Z
TZ
Birkett
D H
DH
Hirsch
E F
EF
D000328:Adult; D001900:Boston / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D016099:Endoscopy, Gastrointestinal; D002149:Energy Intake; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects* / Q000451:nursing; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D007582:Jejunostomy / Q000009:adverse effects* / Q000451:nursing; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011015:Pneumonia, Aspiration / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D011228:Prealbumin / Q000032:analysis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013270:Stomach / Q000382:microbiology; D016896:Treatment Outcome
D011228:Prealbumin