Randomized comparison of nasojejunal and nasogastric feeding in critically ill patients.
OBJECTIVE
Critically ill patients often develop large gastric residual volumes during nasogastric feeding as a result of poor gastroduodenal motility. Nasojejunal feeding may decrease the severity of this complication. The aim of this study was to determine whether nasojejunal feeding improved tolerance of enteral nutrition by reducing gastric residual volumes.


METHODS
Randomized, prospective, clinical study.


METHODS
Intensive care unit of a university-affiliated hospital.


METHODS
Seventy-three intensive care unit patients expected to require nutritional support for at least 3 days.


METHODS
Patients were randomized to receive enteral nutrition via a nasojejunal tube (placed endoscopically) (34 patients) or a nasogastric tube (39 patients). A strict protocol was followed, which included regular gastric residual volume measurement (in both groups), the use of predetermined criteria for intolerance, and an attempt at nasojejunal feeding for those nasogastrically fed patients who were intolerant of enteral nutrition.


RESULTS
Endoscopic placement of nasojejunal tubes was successful in 98% with no complications of insertion. Patients fed via a nasojejunal tube had 1) a reduced total gastric residual volume in both the first 24 (197 vs. 491 mL, p = .02) and 48 hrs (517 vs. 975 mL, p = .02); 2) a reduced incidence of a single gastric residual volume >150 mL (32% vs. 74%, p = .001); and 3) a trend toward a reduced incidence of intolerance of enteral nutrition (13% vs. 31%, p = .09). Only 13% of those nasogastrically fed patients who were initially intolerant of enteral nutrition remained intolerant once fed via a nasojejunal tube, and only 1.4% of all patients met criteria for commencement of parenteral nutrition.


CONCLUSIONS
Enteral nutrition delivered via a nasojejunal tube is associated with a significant reduction in gastric residual volume, a strong trend toward improved tolerance of enteral nutrition, and an extremely low requirement for parenteral nutrition.
Davies
Andrew R
AR
Department of Intensive Care, Austin and Repatriation Medical Centre, Melbourne, Victoria, Australia.
Froomes
Paul R A
PR
French
Craig J
CJ
Bellomo
Rinaldo
R
Gutteridge
Geoffrey A
GA
Nyulasi
Ibolya
I
Walker
Robyn
R
Sewell
Richard B
RB
D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D007362:Intensive Care Units; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D007583:Jejunum; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies