The incidence of ventilator-associated pneumonia and success in nutrient delivery with gastric versus small intestinal feeding: A randomized clinical trial
Abstract
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.
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In an ICU population fed through percutaneous endoscopic gastrostomy, bolus and continuous tube feeding achieved the same gastric volumes, insulin requirements, time to goal therapy or calorie intake.
“In an ICU population fed through percutaneous endoscopic gastrostomy, bolus and continuous tube feeding achieved the same gastric volumes, insulin requirements, time to goal therapy or calorie intake (83).”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [83]
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ESPEN guideline on clinical nutrition in the intensive care unit.
Singer, P., Blaser, A. R., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., Hiesmayr, M., Mayer, K., Montejo, J. C., Pichard, C., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.08.037 · Cited by 2,904 · see citing works
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Early versus late enteral feeding of mechanically ventilated patients: Results of a clinical trial.
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- Authors
- Kearns, P. J., Chin, D., Mueller, L., Wallace, K., Jensen, W. A., & Kirsch, C. M.
- Affiliations
- Santa Clara Valley Medical Center (US)
- ORCID
- Wallace, Karen
- Venue
- Critical Care Medicine
- Published
- 2000-06
- Volume
- 28
- Issue
- 6
- Pages
- 1742-1746
- ISSN
- 0090-3493 (ISSN-L)
- OpenAlex
- W2088026862
- Cited by
- 223
- References
- 0
- Citations by year
- 2025: 3 · 2024: 1 · 2022: 11 · 2021: 3 · 2020: 3 · 2019: 6 · 2018: 6 · 2017: 6 · 2016: 9 · 2015: 8 · 2014: 11 · 2013: 11 · 2012: 11
- FWCI
- 14.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Health Sciences › Health Professions › Emergency Medical Services › Central Venous Catheters and Hemodialysis
- Keywords
- ventilator-associated pneumonia, enteral nutrition, gastric tube feeding, duodenal intubation, mechanical ventilation, endotracheal intubation, nutritional adequacy, energy intake, intensive care unit patients, mortality
- MeSH terms
- Enteral Nutrition, Female, Humans, Intestine, Small, Male, Middle Aged, Pneumonia, Prospective Studies, Ventilators, Mechanical, Stomach, Incidence
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