A comparison of early gastric and post-pyloric feeding in critically ill patients: a meta-analysis

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Abstract

Objective:

To investigate the potential beneficial and adverse effects of early post-pyloric feeding compared with gastric feeding in critically ill adult patients with no evidence of impaired gastric emptying.

Design:

Randomised controlled studies comparing gastric and post-pyloric feeding in critically ill adult patients from Cochrane Controlled Trial Register (2005 issue 3), EMBASE and MEDLINE databases (1966 to 1 October 2005) without any language restriction were included. Two reviewers reviewed the quality of the studies and performed data extraction independently.

Measurements and results:

Eleven randomised controlled studies with a total of 637 critically ill adult patients were considered. The mortality (relative risk [RR] 1.01, 95% CI 0.76–1.36, p = 0.93; I2 = 0%) and risk of aspiration or pneumonia (RR 1.28, 95% CI 0.91–1.80, p = 0.15; I2 = 0%) were not significantly different between patients treated with gastric or post-pyloric feeding. The effect of post-pyloric feeding on the risk of pneumonia or aspiration was similar when studies were stratified intothose with and those without the use of concurrent gastric decompression (RR ratio 0.95, 95% CI 0.48–1.91, p = 0.89). The risk of diarrhoea and the length of intensive care unit stay (weighted mean difference in days -1.46, 95% CI -3.74 to 0.82, p = 0.21; I2 = 24.6%) were not statistically different. The gastric feeding group had a much lower risk of experiencing feeding tube placement difficulties or blockage (0 vs 9.6%, RR 0.13, 95% CI 0.04–0.44, p = 0.001; I2 = 0%).

Conclusions:

Early use of post-pyloric feeding instead of gastric feeding in critically ill adult patients with no evidence of impaired gastric emptying was not associated with significant clinical benefits.

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