Gastric versus transpyloric feeding in severe traumatic brain injury: a prospective, randomized trial.
OBJECTIVE
To evaluate the efficacy of transpyloric feeding (TPF) compared with gastric feeding (GF) with regard to the incidence of ventilator-associated pneumonia in severe traumatic brain injury patients (TBI).


METHODS
Prospective, open-label, randomized study in an intensive care unit of a university hospital.


METHODS
One hundred and four CHI adult patients admitted for TBI between April 2007 and December 2008. Patients were included within the first 24 h after ICU admission and were followed until discharge or 30 days after admission.


METHODS
Patients were randomized to TPF or GF groups. They received the same diet, with 25 kcal kg(-1) day(-1) of calculated energy requirements and a nitrogen intake of 0.2 g N kg(-1) day(-1). Primary outcome was the incidence of early and ventilatory-associated pneumonia. Secondary outcomes were enteral nutrition-related gastrointestinal complications (GIC), days on mechanical ventilation, length of ICU stay and hospital stay, and sequential organ failure assessment score (SOFA).


RESULTS
The TPF group had a lower incidence of pneumonia, OR 0.3 (95% CI 0.1-0.7, P = 0.01). There were no significant differences in other nosocomial infections. The TPF group received higher amounts of diet compared to the GF group (92 vs. 84%, P < 0.01) and had lesser incidence of increased gastric residuals, OR 0.2 (95% CI 0.04-0.6, P = 0.003).


CONCLUSIONS
Enteral nutrition delivered through the transpyloric route reduces the incidence of overall and late pneumonia and improves nutritional efficacy in severe TBI patients.
Acosta-Escribano
Jose
J
Intensive Care Unit, Hospital General Universitario de Alicante, Pintor Baeza 12, 03010, Alicante, Spain. acosta_jos@telefonica.net
Fernández-Vivas
Miguel
M
Grau Carmona
Teodoro
T
Caturla-Such
Juan
J
Garcia-Martinez
Miguel
M
Menendez-Mainer
Ainhoa
A
Solera-Suarez
Manuel
M
Sanchez-Payá
José
J
D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000628:therapy*; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D011708:Pylorus