title: Gastric vs small-bowel feeding in critically ill children receiving mechanical ventilation: a randomized controlled trial.
abstract: OBJECTIVE
  To determine the effect of feeding tube position (gastric vs small bowel) on adequacy of nutrient delivery and feeding complications, including microaspiration, in critically ill children.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Pediatric ICU in a university teaching hospital.
  
  
  METHODS
  Seventy-four critically ill patients < 18 years of age receiving mechanical ventilation were randomized to receive gastric or small-bowel feeding.
  
  
  METHODS
  All feeding tubes were inserted at the bedside. Color, pH, and bilirubin concentration of the feeding tube aspirates were used to guide placement. Final tube position was confirmed radiographically. Continuous feedings were advanced to achieve a caloric goal based on age and body weight. Tracheal secretions were collected daily and tested for gastric pepsin by immunoassay.
  
  
  RESULTS
  Thirty-two patients were randomized to the gastric group, and 42 patients were randomized to the small-bowel group. Twelve patients exited the study because a small-bowel tube could not be placed at the bedside, leaving 30 patients in the small-bowel group. Gastric and small-bowel groups were similar at baseline in age, sex, percentage of ideal body weight, serum prealbumin concentration, and pediatric risk of mortality score. The percentage of daily caloric goal achieved was less in the gastric group compared to the small-bowel group (30 +/- 23% vs 47 +/- 22%, p < 0.01). No difference was found in the proportion of tracheal aspirates positive for pepsin between the gastric and small-bowel groups (50 of 146 aspirates vs 50 of 172 aspirates, respectively; p = 0.3). No differences were found in the frequency of feeding tube displacement, abdominal distension, vomiting, or diarrhea between groups.
  
  
  CONCLUSIONS
  Small-bowel feeds allow a greater amount of nutrition to be successfully delivered to critically ill children. Small-bowel feeds do not prevent aspiration of gastric contents.
authors.affiliation: Critical Care Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA. kmeert@med.wayne.edu
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Meert
authors.forename: Kshama M
authors.initials: KM
authors.lastname: Daphtary
authors.forename: Norma A
authors.initials: NA
authors.lastname: Metheny
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D002149:Energy Intake; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D004766:Enterostomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007223:Infant; D007421:Intestine, Small; D008297:Male; D015596:Nutrition Assessment; D012121:Respiration, Artificial; D016896:Treatment Outcome