Severity of illness influences the efficacy of enteral feeding route on clinical outcomes in patients with critical illness.
BACKGROUND
Few trials have studied the influence of illness severity on clinical outcomes of different tube-feeding routes. Whether gastric or postpyloric feeding route is more beneficial to patients receiving enteral nutrition remains controversial.


OBJECTIVE
To test whether illness severity influences the efficacy of enteral feeding route on clinical outcomes in patients with critical illness.


METHODS
A 2-year prospective, randomized, clinical study was conducted to assess the differences between the nasogastric (NG) and nasoduodenal (ND) tube feedings on clinical outcomes.


METHODS
One hundred one medical adult intensive care unit (ICU) patients requiring enteral nutrition were enrolled in this study.


METHODS
Patients were randomly assigned to the NG (n=51) or ND (n=50) feeding route during a 21-day study period. Illness severity was dichotomized as "less severe" and "more severe," with the cutoff set at Acute Physiology and Chronic Health Evaluation II score of 20.


METHODS
Daily energy and protein intake, feeding complications (eg, gastric retention/vomiting/diarrhea/gastrointestinal bleeding), length of ICU stay, hospital mortality, nitrogen balance, albumin, and prealbumin.


METHODS
Two-tailed Student t tests and Mann-Whitney U tests were used to analyze significant differences between variables in the study groups. Multiple regression was used to assess the effects of illness severity and enteral feeding routes on clinical outcomes.


RESULTS
Among less severely ill patients, no differences existed between the NG and ND groups in daily energy and protein intake, feeding complications, length of ICU stay, and nitrogen balance. Among more severely ill patients, the NG group experienced lower energy and protein intake, more tube feeding complications, longer ICU stay, and poorer nitrogen balance than the ND group.


CONCLUSIONS
To optimize nutritional support and taking medical resources into account, the gastric feeding route is recommended for less severely ill patients and the postpyloric feeding route for more severely ill patients.
Department of Life Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, No. 1 University Rd., Tainan City 701, Taiwan.
Hsiu-Hua
HH
Huang
Sue-Joan
SJ
Chang
Chien-Wei
CW
Hsu
Tzu-Ming
TM
Chang
Shiu-Ping
SP
Kang
Ming-Yi
MY
Liu
D018806:APACHE; D000368:Aged; D016638:Critical Illness / Q000628:therapy*; D004044:Dietary Proteins / Q000008:administration & dosage; D004386:Duodenum; D002149:Energy Intake / Q000502:physiology; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007441:Intubation, Gastrointestinal / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000378:metabolism; D011183:Postoperative Complications; D011446:Prospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D004044:Dietary Proteins; D009584:Nitrogen