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Gastric-tube versus post-pyloric feeding in critical patients: a systematic review and meta-analysis of pulmonary aspiration- and nutrition-related outcomes

Abstract

Gastric-tube feeding and post-pyloric feeding are the two most common forms of enteral nutrition, each with advantages and disadvantages. To explore the effects and safety of gastric-tube versus post-pyloric feeding in critical patients by comparing pulmonary aspiration- and nutrition-related outcomes, a meta-analysis was conducted. It was performed by systematically searching the following databases: PubMed, EMBASE, Cochrane library, BMJ best practice, ProQuest dissertations and theses, CINAHL, web of science, SinoMed, WANFANG, CNKI, and the platform of clinical trial registration. The databases were searched through December 31, 2019, and studies were evaluated by two independent researchers. Review Manager software was used for data analysis. We included 41 studies conducted in ten countries and involving 3248 participants. Meta-analysis showed that post-pyloric feeding had a lower incidence rate of pulmonary aspiration, gastric reflux, and pneumonia (P < 0.001, all), less incidence of gastrointestinal complications including vomiting, nausea, diarrhea, abdominal distension, high gastric residual volume, and constipation (P < 0.05, all), more optimal gastrointestinal nutrition including the percentage of total nutrition provided to the patient, the time to tolerate enteral nutrition, the time required to start feeding and the time required to reach nutritional targets (P < 0.05, all), shorter length of mechanical ventilation, stay in ICU and stay in hospital (P < 0.001, all), compared with gastric-tube feeding. No significant differences were shown in the time of gastrointestinal function recovery, mortality, or hospitalization expenses between the two feeding routes. This review provides evidence that post-pyloric feeding appears to be the safer and more effective choice, as compared to gastric-tube feeding among critical patients.

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Funding

This research was funded by Capital Medical University Nature Project (Grant No. PYZ2018026).

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YL conceived and designed the study; acquired, analyzed, and interpreted the data; and drafted and revised the manuscript. YLW contributed to study design, data analysis, and manuscript revision. JNW contributed to data acquisition and analysis, and the drafting of the manuscript. BHZ contributed to data acquisition and analysis, and the drafting of the manuscript. LS contributed to data analysis and the drafting of the manuscript. QX contributed to study conception and design, data analysis and interpretation, and manuscript review and revision. All authors approved the final version of the manuscript.

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Correspondence to Qian Xiao.

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Liu, Y., Wang, Y., Zhang, B. et al. Gastric-tube versus post-pyloric feeding in critical patients: a systematic review and meta-analysis of pulmonary aspiration- and nutrition-related outcomes. Eur J Clin Nutr 75, 1337–1348 (2021). https://doi.org/10.1038/s41430-021-00860-2

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