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Multicenter, prospective, randomized, single-blind study comparing the efficacy and gastrointestinal complications of early jejunal feeding with early gastric feeding in critically ill patients

Montejo, Juan C. MD; Grau, Teodoro MD; Acosta, Jose MD; Ruiz-Santana, Sergio MD; Planas, Mercé MD; García-de-Lorenzo, Abelardo MD; Mesejo, Alfonso MD; Cervera, Manuel MD; Sánchez-Álvarez, Carmen MD; Núñez-Ruiz, Rafael MD; López-Martínez, Jorge MD for the Nutritional and Metabolic Working Group of the Spanish Society of Intensive Care Medicine and Coronary Units

CLINICAL INVESTIGATIONS
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Objective  To compare the incidence of enteral nutrition-related gastrointestinal complications, the efficacy of diet administration, and the incidence of nosocomial pneumonia in patients fed in the stomach or in the jejunum.

Design  Prospective, randomized multicenter study.

Setting  Intensive care units (ICUs) in 11 teaching hospitals.

Patients  Critically ill patients who could receive early enteral nutrition more than 5 days.

Interventions  Enteral nutrition was started in the first 36 hrs after admission. One group was fed with a nasogastric tube (GEN group) and the other in the jejunum through a dual-lumen nasogastrojejunal tube (JEN group).

Measurements and Main Results  Gastrointestinal complications were previously defined. The efficacy of diet administration was calculated using the volume ratio (expressed as the ratio between administered and prescribed volumes). Nosocomial pneumonia was defined according the Centers for Disease Control and Prevention’s definitions. One hundred ten patients were included (GEN: 51, JEN: 50). Both groups were comparable in age, gender, Acute Physiology and Chronic Health Evaluation II, and Multiple Organ Dysfunction Score. There were no differences in feeding duration, ICU length of stay, or mortality (43% vs. 38%). The JEN group had lesser gastrointestinal complications (57% vs. 24%, p < .001), mainly because of a lesser incidence of increased gastric residuals (49% vs. 2%, p < .001). Volume ratio was similar in both groups. A post hoc analysis showed that the JEN group had a higher volume ratio at day 7 than the GEN group (68% vs. 82%, p < .03) in patients from ICUs with previous experience in jejunal feeding. Both groups had a similar incidence of nosocomial pneumonia (40% vs. 32%).

Conclusions  Gastrointestinal complications are less frequent in ICU patients fed in the jejunum. Nevertheless, it seems to be a necessary learning curve to achieve better results with a postpyloric access. Early enteral nutrition using a nasojejunal route seems not to be an efficacious measure to decrease nosocomial pneumonia in critically ill patients.

From the Intensive Care Unit (ICU), Hospital Universitario “12 de Octubre,” Madrid, Spain (JCM); the ICU, Hospital Universitario Getafe Madrid, Spain (TG); the ICU, Hospital Universitario, Alicante, Spain (JA); the ICU, Hospital Universitario “Dr. Negrín,” Las Palmas, Spain (SR-S); the ICU, Hospital Universitario “Vall d’Hebró,” Barcelona, Spain (MP); the ICU, Hospital Universitario “La Paz,” Madrid, Spain (AG-d-L); the ICU, Hospital Universitario Clínico, Valencia, Spain (AM); the ICU, Hospital Universitario “Dr Peset,” Valencia, Spain (MC); the ICU, Hospital Universitario General, Murcia, Spain (CS-A); the ICU, Hospital Universitario “Virgen de la Arrixaca,” Murcia, Spain (RN-R); and the ICU, Hospital Universitario “Severo Ochoa” Leganés, Madrid, Spain (JL-M).

Supported, in part, by Novartis Consumer Health (Spain). Novartis Consumer Health (Spain) supplied, at no charge, the dual-lumen tubes used in the study. Funds were dedicated to the statistical analysis.

Address requests for reprints to: Juan C Montejo, MD, Hospital Universitario 12 de Octubre, Medicina Intensiva, Carretera de Andalucía Km 5,4, 28041 Madrid, Spain. E-mail: jmontejo@hdoc.insalud.es

Gastrointestinal complications are less frequent in intensive care unit patients fed in the jejunum.

© 2002 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins