Gastric versus transpyloric feeding in severe traumatic brain injury: a prospective, randomized trial

Acosta-Escribano, Jose; Fernández-Vivas, Miguel; Grau Carmona, Teodoro; Caturla-Such, Juan; Garcia-Martinez, Miguel; Menendez-Mainer, Ainhoa; Solera-Suarez, Manuel; Sanchez-Payá, José
September 2010
Intensive Care Medicine;Sep2010, Vol. 36 Issue 9, p1532
Academic Journal
To evaluate the efficacy of transpyloric feeding (TPF) compared with gastric feeding (GF) with regard to the incidence of ventilator-associated pneumonia in severe traumatic brain injury patients (TBI). Prospective, open-label, randomized study in an intensive care unit of a university hospital. One hundred and four CHI adult patients admitted for TBI between April 2007 and December 2008. Patients were included within the first 24 h after ICU admission and were followed until discharge or 30 days after admission. Patients were randomized to TPF or GF groups. They received the same diet, with 25 kcal kg−1 day−1 of calculated energy requirements and a nitrogen intake of 0.2 g N kg−1 day−1. Primary outcome was the incidence of early and ventilatory-associated pneumonia. Secondary outcomes were enteral nutrition-related gastrointestinal complications (GIC), days on mechanical ventilation, length of ICU stay and hospital stay, and sequential organ failure assessment score (SOFA). The TPF group had a lower incidence of pneumonia, OR 0.3 (95% CI 0.1–0.7, P = 0.01). There were no significant differences in other nosocomial infections. The TPF group received higher amounts of diet compared to the GF group (92 vs. 84%, P < 0.01) and had lesser incidence of increased gastric residuals, OR 0.2 (95% CI 0.04–0.6, P = 0.003). Enteral nutrition delivered through the transpyloric route reduces the incidence of overall and late pneumonia and improves nutritional efficacy in severe TBI patients.


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