Effect of gastric versus post-pyloric feeding on the incidence of pneumonia in critically ill patients: Observations from traditional and Bayesian random-effects meta-analysis

• Published in: Clinical nutrition (Edinburgh, Scotland) Scotland), 2013-02, Vol.32 (1), p.8-15
• Main Authors: Jiyong, Jing, Tiancha, Huang, Huiqin, Wang, Jingfen, Jin
• Format: Article
• Language: English
• Subjects: Aspirations; Bayes Theorem; Biological and medical sciences; confidence interval; Critical Care - methods; Critical illness; Cross Infection - etiology; Cross Infection - prevention & control; enteral feeding; Enteral Nutrition - adverse effects; Enteral Nutrition - methods; Feeding. Feeding behavior; Fundamental and applied biological sciences. Psychology; Gastric feeding; Gastroenterology and Hepatology; Humans; Incidence; Meta-analysis; patients; Pneumonia; Pneumonia - epidemiology; Pneumonia - etiology; Pneumonia - prevention & control; Post-pyloric feeding; randomized clinical trials; Randomized Controlled Trials as Topic; relative risk; Vertebrates: anatomy and physiology, studies on body, several organs or systems; vomiting
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2012.07.002

Summary Background & aims Administration of enteral feeding is associated with a higher risk of nosocomial pneumonia. Herein, we systematically review the impact of gastric versus post-pyloric feeding on the incidence of pneumonia. Methods We searched the MEDLINE, EMBASE, Web of Science, and CCTRD (1966 to August 2011) for studies comparing gastric and post-pyloric feeding in critically ill patients. Two reviewers reviewed the quality of the studies and performed data extraction independently. Main outcome measures were the incidence of nosocomial pneumonia, aspiration, and vomiting. The meta-analysis was performed using traditional and Bayesian random-effects model. Results Our initial searches yielded 563 studies. Of these, we identified 15 randomized clinical trials enrolling 966 participants. Post-pyloric feeding was associated with reduction in pneumonia compared with gastric feeding (relative risk [RR] 0.63, 95% confidence interval [CI] 0.48–0.83, p  = 0.001; I2  = 0%). The risk of aspiration (RR, 1.11; 95% CI, 0.80–1.53, p  = 0.55; I2  = 0%) and vomiting (RR, 0.80; 95% CI, 0.38–1.67, p  = 0.56; I2  = 65.3%) were not significantly different between patients treated with gastric and post-pyloric feeding. Conclusions Comparing with gastric feeding, post-pyloric route can reduce incidence of pneumonia in critically ill patients.