Multicenter, prospective, randomized, single-blind study comparing the efficacy and gastrointestinal complications of early jejunal feeding with early gastric feeding in critically ill patients.
OBJECTIVE
To compare the incidence of enteral nutrition-related gastrointestinal complications, the efficacy of diet administration, and the incidence of nosocomial pneumonia in patients fed in the stomach or in the jejunum.


METHODS
Prospective, randomized multicenter study.


METHODS
Intensive care units (ICUs) in 11 teaching hospitals.


METHODS
Critically ill patients who could receive early enteral nutrition more than 5 days.


METHODS
Enteral nutrition was started in the first 36 hrs after admission. One group was fed with a nasogastric tube (GEN group) and the other in the jejunum through a dual-lumen nasogastrojejunal tube (JEN group).


RESULTS
Gastrointestinal complications were previously defined. The efficacy of diet administration was calculated using the volume ratio (expressed as the ratio between administered and prescribed volumes). Nosocomial pneumonia was defined according the Centers for Disease Control and Prevention's definitions. One hundred ten patients were included (GEN: 51, JEN: 50). Both groups were comparable in age, gender, Acute Physiology and Chronic Health Evaluation II, and Multiple Organ Dysfunction Score. There were no differences in feeding duration, ICU length of stay, or mortality (43% vs. 38%). The JEN group had lesser gastrointestinal complications (57% vs. 24%, p <.001), mainly because of a lesser incidence of increased gastric residuals (49% vs. 2%, p <.001). Volume ratio was similar in both groups. A post hoc analysis showed that the JEN group had a higher volume ratio at day 7 than the GEN group (68% vs. 82%, p <.03) in patients from ICUs with previous experience in jejunal feeding. Both groups had a similar incidence of nosocomial pneumonia (40% vs. 32%).


CONCLUSIONS
Gastrointestinal complications are less frequent in ICU patients fed in the jejunum. Nevertheless, it seems to be a necessary learning curve to achieve better results with a postpyloric access. Early enteral nutrition using a nasojejunal route seems not to be an efficacious measure to decrease nosocomial pneumonia in critically ill patients.
Montejo
Juan C
JC
Intensive Care Unit (ICU), Hospital Universitario "12 de Octubre," Madrid, Spain. tmontejo@hdoc.insalud.es
Grau
Teodoro
T
Acosta
Jose
J
Ruiz-Santana
Sergio
S
Planas
Mercé
M
García-De-Lorenzo
Abelardo
A
Mesejo
Alfonso
A
Cervera
Manuel
M
Sánchez-Alvarez
Carmen
C
Núñez-Ruiz
Rafael
R
López-Martínez
Jorge
J
D016638:Critical Illness / Q000628:therapy*; D003428:Cross Infection / Q000209:etiology; D004750:Enteral Nutrition / Q000009:adverse effects; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology*; D006801:Humans; D007441:Intubation, Gastrointestinal; D007583:Jejunum; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology; D011183:Postoperative Complications; D011446:Prospective Studies; D016037:Single-Blind Method; D013270:Stomach; D016896:Treatment Outcome