Effects of gastric versus small bowel feeding on hospital acquired pneumonia in critically ill patients: a meta-analysis

Abstract

To explore whether or not small bowel feeding can reduce the incidence of hospital acquired pneumonia (HAP). The databases of Pubmed, Embase and Web of Science were searched to identify the relevant randomized controlled trials (RCT) from January 1992 to September 2012. Meta analysis was performed to analyze the effects of gastric versus small bowel feeding on HAP. Ten RCTs including 830 patients were retrieved and 6 of which examined the effect of ventilator-associated pneumonia (VAP). In total, the incidence of HAP was 15% (62/407) in bowel feeding group versus 23% (97/423) in gastric feeding group. As compared with gastric feeding, small bowel feeding appeared to significantly reduce the incidence of HAP [RR 0.67, 95%CI(0.51-0.89), P = 0.005; I(2) = 0%)], but did not reduce the mortality [RR 1.08, 95%CI(0.84-1.40), P = 0.54; I(2) = 0%] and the duration of ICU stay [weighted mean difference in 0.04 days, 95%CI(-2.83-2.91), P = 0.98; I(2) = 96%]. Subgroup analysis indicated that small bowel nutrition reduced the incidence of VAP [RR 0.64, 95%CI(0.46-0.90), P = 0.01; I(2) = 9%)], but did not reduce the incidence HAP of non-VAP [RR 0.74, 95%CI(0.45-1.21), P = 0.23; I(2) = 0%)]. Compared with gastric feeding, small bowel feeding can reduce the incidence of HAP, especially VAP, but can not reduce the mortality.