An integrated systematic review and meta-analysis of published randomized controlled trials evaluating nasogastric against postpyloris (nasoduodenal and nasojejunal) feeding in critically ill patients admitted in intensive care unit

Abstract

This article presents the systematic review of the randomized, controlled trials comparing the effectiveness of nasogastric (NG) versus postpyloris (PP) feeding in critically ill surgical patients and other patients in intensive therapy unit (ITU). Twenty randomized trials recruiting 1496 patients were retrieved from the standard electronic databases. There were 760 patients in the NG feeding group and 736 patients in the PP feeding group. There was significant heterogeneity among trials. PP feeding in ITU patients was associated with lower gastric residual volume (odds ratio (OR), 3.95; 95% confidence interval (CI), 1.19, 13.14; z = 2.24; P<0.03; I(2) = 73%) and a reduced risk of developing aspiration pneumonia (OR, 1.41; 95% CI, 1.01, 1.98; z = 2.03; P<0.04; I(2) = 10%) compared with NG feeding. In addition, higher proportion of caloric requirements (standardized mean difference, -1.02; 95% CI, -1.73, -0.31; z = 2.82; P<0.005; I(2) = 95%) could be delivered with PP feeding. Risk of gastrointestinal complications, overall mortality and length of ITU stay were similar between the two techniques of enteral feeding. In summary, PP feeding in ITU patients reduces the gastric residual volume and risk of aspiration pneumonia. PP feeding is also superior to NG feeding in terms of delivering higher proportion of daily caloric requirements. PP feeding with the help of nasoduodenal or nasojejunal tube may be used routinely in ITU patients for nutritional support.