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Gastric versus post-pyloric feeding: a systematic review
1Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. pmarik@zbzoom.net
Critical Care (London, England)
|June 10, 2003
Summary
Gastric feeding was initiated sooner than post-pyloric feeding in critically ill patients. This meta-analysis found no significant differences in pneumonia, ICU length of stay, or mortality between the two enteral nutrition methods.
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Nutritional Support
Background:
- Enteral nutrition is crucial for critically ill patients.
- The optimal route for feeding (gastric vs. post-pyloric) remains debated.
- Pneumonia, caloric intake, ICU length of stay (LOS), and mortality are key outcomes.
Purpose of the Study:
- To compare the impact of gastric versus post-pyloric feeding on critical care outcomes.
- To evaluate incidence of pneumonia, caloric intake, ICU LOS, and mortality.
- To synthesize evidence from randomized controlled trials.
Main Methods:
- Systematic review and meta-analysis of prospective randomized controlled trials.
- Searched Medline, Embase, Healthstar, and other sources.
- Included 9 trials with 522 critically ill patients (medical, neurosurgical, trauma).
Main Results:
- No significant differences in pneumonia incidence, caloric intake, ICU LOS, or mortality.
- Gastric feeding was initiated significantly sooner than post-pyloric feeding.
- Time to reach caloric goal did not differ between groups.
Conclusions:
- Post-pyloric feeding offers no demonstrable clinical benefit over gastric feeding in mixed ICU populations.
- Gastric feeding allows for earlier initiation of enteral nutrition.
- Limitations include a small total sample size.
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