Abstract
A prospective study was carried out over a 10-month period to compare nutritional status, gastric colonization, and rates of nosocomial pneumonia in intensive care unit (ICU) patients randomized to either gastric tube feeding or feeding by an endoscopically placed jejunal tube. Sixty-nine patients were considered eligible for the study. Thirty-eight patients were enrolled from medical and surgical ICUs at two hospitals and were equally divided into two groups. The groups were similar in age, sex, race, underlying disease, type of surgical procedure, number of days fed, duration of ICU stay, duration of mechanical ventilation, days with fever, and days of antibiotic therapy. The jejunal tube (JT) group had more patients who were in circulatory shock on admission (79%) than the gastric feeding (GT) group (68.4%). Additionally, the JT group had higher Acute Physiology Scores (24.0 vs 21.7) and fewer patients with pneumonia at the time of entry into the study (26.3% us 31.6%). The JT patients received a significantly higher percentage of their daily goal caloric intake ( p < .05) and had a significantly greater increase in serum prealbumin concentration (p < .05) than the GT patients. The difference in incidence of diarrhea between the two groups was not statistically significant (JT: 3.3 ± 6.6 days; GT: 1.8 ± 2.9 days). Two patients in the GT group (10.5%) and none in the JT group developed nosocomial pneumonia. In a subset of 12 patients from both groups (JT: n = 5; GT: n = 7), quantitative cultures of the pharynx, stomach, and sputum were carried out. No significant differences in the median levels of colonization with Gram-negative bacilli were seen between the two groups (at each site); similarly, the numbers of Gram-positive cocci and Candida species for the two groups were similar at all sites.
The authors concluded that patients fed by JT received a significantly higher proportion of their daily caloric intake, had a significantly greater increase in serum prealbumin concentrations, and had a lower rate of pneumonia than patients fed by continuous GT.
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