Liu Chuanjin, Jiang Junxun, Wen Zunjia, You Tao
Department of Critical Care Medicine, Division II, Pingxiang People's Hospital, Pingxiang, China.
Department of Neurosurgery, Pingxiang People's Hospital, Pingxiang, Jiangxi Province, 337000, China.
Syst Rev. 2025 Jan 14;14(1):13. doi: 10.1186/s13643-024-02743-6.
A systematic appraisal of the comparative efficacy and safety profiles of naso-intestinal tube versus gastric tube feeding in the context of enteral nutrition for mechanically ventilated (MV) patients is imperative. Such an evaluation is essential to inform clinical practice, ensuring that the chosen method of nutritional support is both optimal and safe for this patient population.
We executed an exhaustive search across PubMed et al. databases to identify randomized controlled trials (RCTs) that scrutinize the role of naso-intestinal and gastric tubes for mechanically ventilated (MV) patients up to May 30, 2024. The process of study selection, quality assessment, and data extraction was conducted independently by two researchers. RevMan 5.3 software was used for meta-analysis.
Our meta-analysis included 8 RCTs, published between 1992 and 2018, encompassing a total of 676 MV patients. The results indicated that naso-intestinal tube feeding, compared to gastric tube feeding, was associated with a significant reduction in the incidence of ventilator-associated pneumonia (VAP) [Risk Ratio (RR) = 0.69, 95% confidence interval (CI) (0.52, 0.92)] and gastric retention (RR = 0.11, 95% CI (0.04, 0.28)). No statistically significant differences were observed in the incidence of aspiration (RR = 0.93, 95% CI (0.35, 2.50)) vomiting (RR = 0.70, 95% CI (0.23, 2.08)), abdominal distension (RR = 0.87, 95% CI (0.29, 2.63)), or diarrhea (RR = 1.10, 95% CI (0.77, 1.55)).
The current evidence indicates that naso-intestinal tube feeding is efficacious in lowering the incidence of VAP and gastric retention among MV patients, without a corresponding escalation in the risk of adverse events, including aspiration, vomiting, abdominal distension, and diarrhea. These insights significantly augment the existing corpus of knowledge pertaining to the optimization of enteral nutrition strategies for patients on mechanical ventilation.
对机械通气（MV）患者肠内营养时鼻肠管与胃管喂养的比较疗效和安全性进行系统评估势在必行。这样的评估对于指导临床实践至关重要，可确保为该患者群体选择的营养支持方法既最佳又安全。
我们在PubMed等数据库中进行了详尽搜索，以识别截至2024年5月30日对机械通气（MV）患者鼻肠管和胃管作用进行审查的随机对照试验（RCT）。研究选择、质量评估和数据提取过程由两名研究人员独立进行。使用RevMan 5.3软件进行荟萃分析。
我们的荟萃分析纳入了1992年至2018年发表的8项RCT，共涵盖676例MV患者。结果表明，与胃管喂养相比，鼻肠管喂养与呼吸机相关性肺炎（VAP）发病率显著降低[风险比（RR）=0.69，95%置信区间（CI）（0.52，0.92）]和胃潴留（RR =0.11，95% CI（0.04，0.28））相关。在误吸（RR =0.93，95% CI（0.35，2.50））、呕吐（RR =0.70，95% CI（0.23，2.08））、腹胀（RR =0.87，95% CI（0.29，2.63））或腹泻（RR =1.10，95% CI（0.77，1.55））的发病率方面未观察到统计学显著差异。
当前证据表明，鼻肠管喂养在降低MV患者VAP发病率和胃潴留方面有效，且在包括误吸、呕吐、腹胀和腹泻在内的不良事件风险方面没有相应增加。这些见解显著扩充了有关机械通气患者肠内营养策略优化的现有知识体系。
