Huang HH, Chang SJ, Hsu CW, Chang TM, Kang SP, Liu MY. Severity of illness influences the efficacy of enteral feeding route on clinical outcomes in patients with critical illness.
J Acad Nutr Diet 2012;
112:1138-46. [PMID:
22682883 DOI:
10.1016/j.jand.2012.04.013]
[Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 04/14/2012] [Indexed: 02/07/2023]
Abstract
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.
DESIGN
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.
PARTICIPANTS/SETTING
One hundred one medical adult intensive care unit (ICU) patients requiring enteral nutrition were enrolled in this study.
INTERVENTION
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.
MAIN OUTCOME MEASURES
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.
STATISTICAL ANALYSES PERFORMED
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.
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