Abstract
The aim of this systematic review was to assess the best available evidence on semi-solid nutrients for prevention of complications associated with enteral tube feeding (ETF). PubMed (MEDLINE), EMBASE, Cochrane Central Register of Controlled Trial, Ichushi-web, and World Health Organization International Clinical Trials Registry Platform databases were searched for relevant articles. Randomized controlled trials (RCTs), cluster RCTs, and crossover trials comparing the effects of semi-solid nutrients with those of control interventions in patients on ETF were included in the review. The primary outcome was development of gastroesophageal reflux (GER). Eight RCTs and five crossover trials involving 889 study participants in total were examined via meta-analysis. The meta-analysis showed that semi-solid nutrients significantly decreased the risk of GER (risk ratio 0.39; 95% confidence interval (CI) 0.21 to 0.73) and the GER index (mean difference −2.93; 95% CI −5.18 to −0.68). Dwell time in the stomach was significantly shortened (standardized mean difference (SMD) −0.50; 95% CI −0.99 to −0.02), as was care time defined as the time needed to prepare and administer the nutrient solution (SMD −8.02; 95% CI −10.94 to −5.10). Semi-solid nutrients significantly decrease the risk of GER and the dwell time in the stomach in adult patients.
Highlights
Enteral tube feeding (ETF) plays a major role in the management of patients with poor voluntary food intake, those with chronic neurological or mechanical dysphagia or gut dysfunction, and those who are critically ill [1]
We found that enteral tube feeding (ETF) with semi-solid nutrients did not significantly reduce the risk of constipation
We found that administration of semi-solid nutrients significantly decreased the risk of gastroesophageal reflux (GER), dwell time in the stomach, and care time but had no statistically significant effect on rates of pneumonia, diarrhea, constipation, or leak from the gastrostomy site
Summary
Enteral tube feeding (ETF) plays a major role in the management of patients with poor voluntary food intake, those with chronic neurological or mechanical dysphagia or gut dysfunction, and those who are critically ill [1]. The logistics of administering ETF may appear less complex than those involved in parenteral nutrition, but serious harm and even death can result from the adverse events that can occur during the process of ordering, administering, and monitoring ETF [7]. The potential adverse events associated with ETF include clinical complications such as gastrointestinal complications [2]. High gastric residuals have been reported to occur in 39% of patients receiving ETF, constipation in 15.7%, diarrhea in 2.0–95.0%, abdominal distention in 12.2%, vomiting in 13.2%, nausea in 10–20%, regurgitation in 0.4–6.0%, and pneumonia in 12.5–30.0% [1,6,8,9,10]
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