BACKGROUND: Enteral feeding provides nutrients for patients who require endotracheal tubes and mechanical ventilation. There is a presumed increase in the risk of ventilator-associated pneumonia (VAP) with tube feeding. This has stimulated the development of procedures for duodenal intubation and small intestinal (SI) feeding as primary prophylaxes to prevent VAP. OBJECTIVE: To investigate the rate of VAP and adequacy of nutrient delivery with gastric (G) vs. SI feeding. DESIGN: A prospective, randomized, controlled trial. SETTING:A medical intensive care unit of a county hospital. PATIENTS: A total of 44 endotracheally intubated, mechanically ventilated patients requiring enteral nutrition. INTERVENTION: Subjects were randomized to receive enteral nutrition via G or SI feeding. Protocols directed the placement of the feeding tube and the infusion of enteral nutrition and defined the radiographic and clinical criteria for a diagnosis of VAP. MEASUREMENTS AND OUTCOMES: The incidence of VAP and the adequacy of nutritional supplementation were prospectively followed. The relative risk of VAP with SI was 1.1 (95% confidence interval 0.96-2.44) compared with G. The SI group received a greater percentage of their caloric requirements (SI 69 +/- 7% vs. G 47 +/- 7%, mean +/- SEM, p < .05). Mortality did not differ between G (26 +/- 9%) and SI (24 +/- 10, p = .86). CONCLUSIONS: There is no clear difference in the incidence of VAP in SI compared with G enteral nutrition. Patients given feeding into the SI do receive higher calorie and protein intakes.
RCT Entities:
BACKGROUND: Enteral feeding provides nutrients for patients who require endotracheal tubes and mechanical ventilation. There is a presumed increase in the risk of ventilator-associated pneumonia (VAP) with tube feeding. This has stimulated the development of procedures for duodenal intubation and small intestinal (SI) feeding as primary prophylaxes to prevent VAP. OBJECTIVE: To investigate the rate of VAP and adequacy of nutrient delivery with gastric (G) vs. SI feeding. DESIGN: A prospective, randomized, controlled trial. SETTING: A medical intensive care unit of a county hospital. PATIENTS: A total of 44 endotracheally intubated, mechanically ventilated patients requiring enteral nutrition. INTERVENTION: Subjects were randomized to receive enteral nutrition via G or SI feeding. Protocols directed the placement of the feeding tube and the infusion of enteral nutrition and defined the radiographic and clinical criteria for a diagnosis of VAP. MEASUREMENTS AND OUTCOMES: The incidence of VAP and the adequacy of nutritional supplementation were prospectively followed. The relative risk of VAP with SI was 1.1 (95% confidence interval 0.96-2.44) compared with G. The SI group received a greater percentage of their caloric requirements (SI 69 +/- 7% vs. G 47 +/- 7%, mean +/- SEM, p < .05). Mortality did not differ between G (26 +/- 9%) and SI (24 +/- 10, p = .86). CONCLUSIONS: There is no clear difference in the incidence of VAP in SI compared with G enteral nutrition. Patients given feeding into the SI do receive higher calorie and protein intakes.
Authors: Leonid Koyfman; Andrei Schwartz; Yair Benjamin; Alexander Smolikov; Moti Klein; Evgeni Brotfain Journal: J Crit Care Med (Targu Mures) Date: 2016-08-10
Authors: Jennifer A Sim; M Horowitz; M J Summers; L G Trahair; R S Goud; A V Zaknic; T Hausken; J D Fraser; M J Chapman; K L Jones; A M Deane Journal: Intensive Care Med Date: 2012-10-25 Impact factor: 17.440
Authors: K Reinhart; F Brunkhorst; H Bone; H Gerlach; M Gründling; G Kreymann; P Kujath; G Marggraf; K Mayer; A Meier-Hellmann; C Peckelsen; C Putensen; M Quintel; M Ragaller; R Rossaint; F Stüber; N Weiler; T Welte; K Werdan Journal: Internist (Berl) Date: 2006-04 Impact factor: 0.743