Post-pyloric better than gastric-tube feeding for critically ill patients

In critically ill patients, post-pyloric feeding appears to be the safer and more effective option than gastric-tube feeding, yielding lower rates of gastric reflux, pulmonary aspiration, and complications, a recent meta-analysis has found.

A total of 41 studies were retrieved from the databases of CNKI, WANFANG, SinoMed, Web of Science, CINAHL, ProQuest, BMJ Best Practice, the Cochrane Library, Embase, and PubMed. The cumulative sample included 3,248 participants, in whom outcomes were compared between post-pyloric and gastric-tube feeding.

Pooled analysis of 13 studies, including 836 patients, found that post-pyloric feeding was associated with a significantly lower risk of reflux of gastric contents relative to gastric-tube feeding (risk ratio [RR], 0.22, 95 percent confidence interval [CI], 0.14–0.34; p<0.001).

The likelihood of pulmonary aspiration was likewise significantly suppressed in the post-pyloric feeding group, according to a meta-analysis of 15 studies (RR, 0.45, 95 percent CI, 0.30–0.66; p<0.001), as was that of pneumonia (RR, 0.53, 95 percent CI, 0.45–0.64; p<0.001).

Post-pyloric feeding was also better than gastric-tube feeding in terms of safety, resulting in lower risks of vomiting (RR, 0.63, 95 percent CI, 0.50–0.80; p=0.0001), diarrhoea (RR, 0.82, 95 percent CI, 0.69–0.97; p=0.02), abdominal distension (RR, 0.69, 95 percent CI, 0.52–0.93; p=0.01), high gastric residual volume (RR, 0.26, 95 percent CI, 0.13–0.52; p=0.0001), and constipation (RR, 0.55, 95 percent CI, 0.35–0.97; p=0.01).

“Post-pyloric feeding to administer enteral nutrition in critical patients can reduce the risk of pulmonary aspiration, pneumonia, gastrointestinal and other complications, and provide additional benefits. Post-pyloric feeding appears to be safer and more effective than gastric-tube feeding,” the researchers said.