Davies

A multicenter, randomized controlled trial comparing early nasojejunal with nasogastric nutrition in critical illness

Davies et al. Critical Care Medicine 2012;40(8):2342-2348

Clinical Question

  • Does early nasojejunal feeding improve the delivery of enteral nutrition in comparison to nasogastric nutrition in critically ill patients experiencing poor gastric motility?

Design

  • Randomised controlled trial
  • Stratified by site and presence of vasopressor infusion
  • Block randomisation
  • Non-blinded

Setting

  • 17 medical/surgical ICUs in Australia

Participants

  • Inclusion: Adults patients who were mechanically ventilated and admitted to ICU in last 72hrs, receiving narcotic infusion and had elevated gastric volumes (single measurement >150ml or >500ml in 12hrs)
  • Excluded if contraindication to nasojejunal feeding
  • 181 patients enrolled from 3623 patients screened

Intervention

  • Nasojejunal nutrition through Tiger tube (successful small bowel placement in 87%)

Control

  • Nasogastric nutrition
Patients in both the intervention and control group had energy requirements set by standard protocol. Patients with clinical manifestations of enteral nutrition intolerance received metoclopramide followed by erythromycin

Outcome

  • Primary outcome: proportion of energy requirements delivered from enteral nutrition during ICU stay (up to 28 days)
    • 71% in NG vs. 72% in NJ,  Mean difference 1%, 95% C.I. -3% to 5%, P=0.66.
  • Secondary outcomes
    • Minor haemorrhage more common in NJ (13%) vs. NG (3%), P=0.02
    • No difference in major haemorrhage (2% vs. 2%, P=0.98), or ventilator acquired pneumonia (20% vs. 21%, P=0.94)

Authors’ Conclusions

  • In ICU patients with mildly elevated gastric volumes, early nasojejunal nutrition did not increase energy delivery in comparison to nasogastric nutrition

Strengths

  • Appropriate power calculation
  • Multi-centre
  • Ensured allocation concealment through use of central randomisation
  • Blinding of assessors of diagnosis of ventilator acquired pneumonia

Weaknesses

  • Non-blinded
  • 235 patients not randomised as study staff not available
  • 9% of NG group crossed over to use NJ

The Bottom Line

  • In patients with mildly elevated gastric volumes, who are receiving ~70% of their target nutrition via a nasogastric tube, there is no advantage, and there may be harm from introducing nasojejunal feeding

Links

Full text pdf / abstract /

Editorial, Commentaries or Blogs

  • None

Metadata

Summary author: @davidslessor
Summary date: 12 May 2014
Peer-review editor: @stevemathieu75

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