Marik Paul E, Zaloga Gary P
Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Crit Care. 2003 Jun;7(3):R46-51. doi: 10.1186/cc2190. Epub 2003 May 6.
Our objective was to evaluate the impact of gastric versus post-pyloric feeding on the incidence of pneumonia, caloric intake, intensive care unit (ICU) length of stay (LOS), and mortality in critically ill and injured ICU patients.
Data sources were Medline, Embase, Healthstar, citation review of relevant primary and review articles, personal files, and contact with expert informants. From 122 articles screened, nine were identified as prospective randomized controlled trials (including a total of 522 patients) that compared gastric with post-pyloric feeding, and were included for data extraction. Descriptive and outcomes data were extracted from the papers by the two reviewers independently. Main outcome measures were the incidence of nosocomial pneumonia, average caloric goal achieved, average daily caloric intake, time to the initiation of tube feeds, time to goal, ICU LOS, and mortality. The meta-analysis was performed using the random effects model.
Only medical, neurosurgical and trauma patents were enrolled in the studies analyzed. There were no significant differences in the incidence of pneumonia, percentage of caloric goal achieved, mean total caloric intake, ICU LOS, or mortality between gastric and post-pyloric feeding groups. The time to initiation of enteral nutrition was significantly less in those patients randomized to gastric feeding. However, time to reach caloric goal did not differ between groups.
In this meta-analysis we were unable to demonstrate a clinical benefit from post-pyloric versus gastric tube feeding in a mixed group of critically ill patients, including medical, neurosurgical, and trauma ICU patients. The incidences of pneumonia, ICU LOS, and mortality were similar between groups. Because of the delay in achieving post-pyloric intubation, gastric feeding was initiated significantly sooner than was post-pyloric feeding. The present study, while providing the best current evidence regarding routes of enteral nutrition, is limited by the small total sample size.
我们的目的是评估胃内喂养与幽门后喂养对重症监护病房（ICU）中危重症及受伤患者肺炎发生率、热量摄入、ICU住院时间（LOS）和死亡率的影响。
数据来源为医学期刊数据库（Medline）、荷兰医学文摘数据库（Embase）、健康之星数据库（Healthstar）、对相关原始文献和综述文章的引用回顾、个人档案以及与专家信息提供者的联系。在筛选的122篇文章中，有9篇被确定为前瞻性随机对照试验（共纳入522例患者），这些试验比较了胃内喂养与幽门后喂养，并纳入进行数据提取。两名审阅者独立从论文中提取描述性数据和结局数据。主要结局指标为医院获得性肺炎的发生率、达到的平均热量目标、平均每日热量摄入、开始管饲的时间、达到目标的时间、ICU住院时间和死亡率。采用随机效应模型进行荟萃分析。
纳入分析的研究仅包括内科、神经外科和创伤患者。胃内喂养组和幽门后喂养组在肺炎发生率、达到热量目标的百分比、平均总热量摄入、ICU住院时间或死亡率方面无显著差异。随机接受胃内喂养的患者开始肠内营养的时间显著更短。然而，两组达到热量目标的时间并无差异。
在这项荟萃分析中，我们未能证明在包括内科、神经外科和创伤ICU患者在内的混合危重症患者组中，幽门后喂养相较于胃内管饲有临床益处。两组之间肺炎发生率、ICU住院时间和死亡率相似。由于实现幽门后插管存在延迟，胃内喂养比幽门后喂养显著更早开始。本研究虽然提供了关于肠内营养途径的当前最佳证据，但受总样本量较小的限制。
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