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Severity of Illness Influences the Efficacy of Enteral Feeding Route on Clinical Outcomes in Patients with Critical Illness

      Abstract

      Background

      Few trials have studied the influence of illness severity on clinical outcomes of different tube-feeding routes. Whether gastric or postpyloric feeding route is more beneficial to patients receiving enteral nutrition remains controversial.

      Objective

      To test whether illness severity influences the efficacy of enteral feeding route on clinical outcomes in patients with critical illness.

      Design

      A 2-year prospective, randomized, clinical study was conducted to assess the differences between the nasogastric (NG) and nasoduodenal (ND) tube feedings on clinical outcomes.

      Participants/setting

      One hundred one medical adult intensive care unit (ICU) patients requiring enteral nutrition were enrolled in this study.

      Intervention

      Patients were randomly assigned to the NG (n=51) or ND (n=50) feeding route during a 21-day study period. Illness severity was dichotomized as “less severe” and “more severe,” with the cutoff set at Acute Physiology and Chronic Health Evaluation II score of 20.

      Main outcome measures

      Daily energy and protein intake, feeding complications (eg, gastric retention/vomiting/diarrhea/gastrointestinal bleeding), length of ICU stay, hospital mortality, nitrogen balance, albumin, and prealbumin.

      Statistical analyses performed

      Two-tailed Student t tests and Mann-Whitney U tests were used to analyze significant differences between variables in the study groups. Multiple regression was used to assess the effects of illness severity and enteral feeding routes on clinical outcomes.

      Results

      Among less severely ill patients, no differences existed between the NG and ND groups in daily energy and protein intake, feeding complications, length of ICU stay, and nitrogen balance. Among more severely ill patients, the NG group experienced lower energy and protein intake, more tube feeding complications, longer ICU stay, and poorer nitrogen balance than the ND group.

      Conclusions

      To optimize nutritional support and taking medical resources into account, the gastric feeding route is recommended for less severely ill patients and the postpyloric feeding route for more severely ill patients.

      Keywords

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      Biography

      H.-H. Huang is a doctoral degree candidate, Department of Life Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan City, Taiwan, and chief, Foodservice Management Division, Department of Food and Nutrition, Taipei Veterans General Hospital, Taipei City, Taiwan; at the time of the study, she was chief, Clinical Nutrition Division, Department of Nutrition, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.

      Biography

      S.-J. Chang is a distinguished professor, Department of Life Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan City, Taiwan.

      Biography

      C.-W. Hsu is an assistant professor, Medicine Department, School of Medicine, National Yang-Ming University, Taipei City, Taiwan, and a visiting doctor, Intensive Care Unit, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.

      Biography

      T.-M. Chang is a professor of surgery and vice superintendent, Tungs' Taichung MetroHarbor Hospital, Taichung City, Taiwan.

      Biography

      S.-P. Kang is a nurse, Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.

      Biography

      M.-Y. Liu is chief, Department of Nutrition, Tainan Sin-Lau Hospital, Tainan City, Taiwan.