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?


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


  • 17 medical/surgical ICUs in Australia


  • 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


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


  • 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


  • 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


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


  • 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


Full text pdf / abstract /

Editorial, Commentaries or Blogs

  • None


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

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