A randomised controlled comparison of early post-pyloric versus early gastric feeding to meet nutritional targets in ventilated intensive care patients.
BACKGROUND
To compare outcomes from early post-pyloric to gastric feeding in ventilated, critically ill patients in a medical intensive care unit (ICU).


METHODS
Prospective randomized study. Ventilated patients were randomly assigned to receive enteral feed via a nasogastric or a post-pyloric tube. Post-pyloric tubes were inserted by the bedside nurse and placement was confirmed radiographically.


RESULTS
A total of 104 patients were enrolled, 54 in the gastric group and 50 in the post-pyloric group. Bedside post-pyloric tube insertion was successful in 80% of patients. Patients who failed post-pyloric insertion were fed via the nasogastric route, but were analysed on an intent-to treat basis. A per protocol analysis was also performed. Baseline characteristics were similar for all except Acute Physiology and Chronic Health Evaluation II (APACHE II) score, which was higher in the post-pyloric group. There was no difference in length of stay or ventilator days. The gastric group was quicker to initiate feed 4.3 hours (2.9 - 6.5 hours) as compared to post-pyloric group 6.6 hours (4.5 - 13.0 hours) (P = 0.0002). The time to reach target feeds from admission was also faster in gastric group: 8.7 hours (7.6 - 13.0 hours) compared to 12.3 hours (8.9 - 17.5 hours). The average daily energy and protein deficit were lower in gastric group 73 Kcal (2 - 288 Kcal) and 3.5 g (0 - 15 g) compared to 167 Kcal (70 - 411 Kcal) and 6.5 g (2.8 - 17.3 g) respectively but was only statistically significant for the average energy deficit (P = 0.035). This difference disappeared in the per protocol analysis. Complication rates were similar.


CONCLUSIONS
Early post-pyloric feeding offers no advantage over early gastric feeding in terms of overall nutrition received and complications


BACKGROUND



BACKGROUND
anzctr.org.au:ACTRN12606000367549.
White
Hayden
H
Department of Critical Care, Logan Hospital, University of Queensland, Armstrong Road, Meadowbrook, Brisbane, 4131, Australia. hayden_white@health.qld.gov.au
Sosnowski
Kellie
K
Tran
Khoa
K
Reeves
Annelli
A
Jones
Mark
M
D018806:APACHE; D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods*; D002149:Energy Intake; D004734:Energy Metabolism; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007440:Intubation / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D018579:Patient Selection; D011708:Pylorus; D012121:Respiration, Artificial / Q000379:methods