Saturday, November 26, 2005

Saturday November 26, 2005
Is post pyloric feeding absolute ?

It is not uncommon to find a patient in ICU to go without nutrition for long time only because enteral feeding tube (e.g. dobhoff) is not cleared by x-ray for post pyloric placement. Drs. Marik and Zaloga did meta-analysis of 9 prospective randomized controlled trials of 522 patients from medical, neurosurgical and trauma ICUs and found no difference in incidences of pneumonia, ICU length of stay and mortality between 2 groups (gastric and post-pyloric). Major recommendation made was: Patients who are not at high risk for aspiration should have a nasogastric/orogastric tube placed as early as possible for the initiation of enteral feeding. Small intestinal feeding tube should be considered if patient remain intolerant of gastric tube feeding despite addition of promotility agents or patients who demonstrate significant reflux or documented aspiration.

References: click to get abstract/article
Gastric versus post-pyloric feeding: a systematic review - Critical Care 2003, 7:R46-R51