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Duodenal versus gastric feeding in medical intensive care unit patients: A prospective, randomized, clinical study*

Hsu, Chien-Wei MD; Sun, Shu-Fen MD; Lin, Shoa-Lin MD; Kang, Shiu-Ping RN; Chu, Kuo-An MD; Lin, Chih-Hsun MD; Huang, Hsiu-Hua RD

doi: 10.1097/CCM.0b013e31819ffcda
Continuing Medical Education Article
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CME

Objective: To determine whether medical intensive care unit (ICU) patients receiving nasoduodenal (ND) feedings achieve optimal nutritional support and better clinical outcomes compared with patients receiving nasogastric (NG) feedings.

Design: A prospective, randomized, clinical study.

Setting: Medical ICU of a university-affiliated tertiary medical center.

Patients: One hundred twenty-one medical ICU patients required enteral feeding.

Interventions: Patients were randomized to receive enteral feeding. One group received ND feedings and the other group received NG feedings. All patients followed the same protocol.

Measurements and Main Results: The primary outcome of optimal nutritional support was assessed by measurement of time to goal tube feed rate and daily calorie and protein intake. Secondary clinical outcomes included number of ICU, hospital and ventilator days, number of the days in the study, blood–glucose levels, incidence of vomiting, diarrhea, gastrointestinal bleeding, tube replaced, tube clogged, fever, bacteremia, and ventilator-associated pneumonia (VAP), and mortality rate. Results showed that the ND group had a higher average daily calorie and protein intake compared with NG group and achieved nutritional goals earlier. In terms of clinical outcomes, patients in the ND group had a lower rate of vomiting and VAP. The other clinical outcomes such as number of ICU days, hospital days, ventilator days, blood–glucose level, tube replaced or clogged, diarrhea, gastrointestinal bleeding, fever, bacteremia, and mortality rate were not significantly different between two groups.

Conclusions: Patients who received ND feedings achieved nutritional goals earlier than those who received NG feeding. ND feeding group also has a lower rate of vomiting and VAP in the medical ICU setting.

Attending Physician (C-WH), Intensive Care Unit, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; Attending Physician (S-SF), Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; Assistant Professor (S-SF), School of Medicine, National Yang-Ming University, Taipei, Taiwan; Director of Intensive Care Unit (S-LL), Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; Resident Nurse (S-PK), Nurse Department, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; Instructor (S-PK), Yuh-Ing Junior College of Health Care with Management, Kaohsiung City, Taiwan; Attending Physician (K-AC, C-HL), Chest Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; Dietitian (H-HH), Nutrition Department, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.

Supported by Kaohsiung Veterans General Hospital, No. VGHKS 94-082. All authors received grant support from Kaohsiung Veterans General Hospital.

For information regarding this article, E-mail: cwhsu2003@yahoo.com

© 2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins
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