title: Gastric vs Small Bowel Feeding in Critically Ill Neurologically Injured Patients: Results of a Multicenter Observational Study.
abstract: BACKGROUND
  To evaluate gastric compared with small bowel feeding on nutrition and clinical outcomes in critically ill, neurologically injured patients.
  
  
  METHODS
  International, prospective observational studies involving 353 intensive care units (ICUs) were included. Eligible patients were critically ill, mechanically ventilated with neurological diagnoses who remained in the ICU and received enteral nutrition (EN) exclusively for at least 3 days. Sites provided data, including patient characteristics, nutrition practices, and 60-day outcomes. Patients receiving gastric or small bowel feeding were compared. Covariates including age, sex, body mass index, and Acute Physiology and Chronic Health Evaluation II score were used in the adjusted analyses.
  
  
  RESULTS
  Of the 1691 patients who met our inclusion criteria, 1407 (94.1%) received gastric feeding and 88 (5.9%) received small bowel feeding. Adequacy of calories from EN was highest in the gastric group (60.2% and 52.3%, respectively, unadjusted analysis; P = .001), but this was not significant in the adjusted model (P = .428). The likelihood of EN interruptions due to gastrointestinal (GI) complications was higher for the gastric group (19.6% vs 4.7%, unadjusted model; P = .015). There were no significant differences in the rate of discontinuation of mechanical ventilation (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.66-1.12; P = .270) or the rate of being discharged alive from the ICU (HR, 0.94; 95% CI, 0.72-1.23; P = .641) and hospital (HR, 1.16; 95% CI, 0.87-1.55; P = .307) after adjusting for confounders.
  
  
  CONCLUSIONS
  Despite a higher likelihood of EN interruptions due to GI complications, gastric feeding may be associated with better nutrition adequacy, but neither route is associated with better clinical outcomes.
authors.affiliation: Department of Nutritional Sciences, School of Health Related Professions, Rutgers, The State University of New Jersey, Newark, New Jersey Food & Nutrition Services, Fraser Health Authority, British Columbia, Canada delara.saran@fraserhealth.ca.
authors.forename: Delara
authors.initials: D
authors.lastname: Saran
authors.affiliation: Department of Nutritional Sciences, School of Health Related Professions, Rutgers, The State University of New Jersey, Newark, New Jersey.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Brody
authors.affiliation: Department of Nutritional Sciences, School of Health Related Professions, Rutgers, The State University of New Jersey, Newark, New Jersey.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Stankorb
authors.affiliation: Department of Nutritional Sciences, School of Health Related Professions, Rutgers, The State University of New Jersey, Newark, New Jersey.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Parrott
authors.affiliation: Clinical Evaluation Research Unit, Kingston General Hospital, Ontario, Canada Department of Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000628:therapy*; D002149:Energy Intake; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology; D006801:Humans; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000628:therapy*; D012121:Respiration, Artificial; D013270:Stomach
keywords: brain injuries; critical care; enteral access; enteral nutrition; head injury; nutrition; nutrition support practice