Abstract
Background: pulmonary aspiration is a common clinical event in critically ill patients. Enteral nutrition is one of established predisposing factors for pulmonary aspiration. This study aimed to evaluate the safety and effectiveness of nasointestinal tube versus nasogastric tube for preventing pulmonary aspiration in critically ill patients. Methods: We systematically searched English (Cochrane Library, PubMed, EMBASE) and Chinese databases (CBM, CNKI and WANFANG), update to December 31, 2018. The studies have no limitation on the language, but only for human research. We include the randomized controlled trials (RCTs) and quasiexperimental studies comparing nasointestinal versus nasogastric tube feeding in critically ill patients aged 18 and over. Data extraction and evaluated trial quality were conducted separately by two researchers, including primary outcomes (pulmonary aspiration, aspiration pneumonia) and secondary outcomes (length of hospital stay, vomiting, etc). Meta-analysis and narrative synthesis were performed. Results: We pooled data from 21 English trials and 65 Chinese trials of 6126 participants in this meta-analysis. Meta-analysis showed that the incidence of reflux of gastric contents (RR 0.2, 95% CI 0.16 to 0.25), pulmonary aspiration (RR 0.32, 95% CI 0.25 to 0.40) and aspiration pneumonia (RR 0.48, 95% CI 0.41 to 0.56) was reduced in patients with nasointestinal feeding, compared with nasogastric tube feeding. Patients with nasointestinal feeding showed lower gastric residual volume (RR 0.23, 95% CI 0.17 to 0.31), lower frequency of vomiting (RR 0.38, 95% CI 0.27 to 0.55), less length of hospital stay (mean difference (MD) -3.02 days, 95% CI -4.95 to -1.09) and intensive care unit (ICU) length of stay (MD -3.12 days, 95% CI -4.33 to -1.09) than that with nasogastric tube feeding. Conclusions: Evidence from this study shows that nasointestinal tube feeding may be more safety on reducing the incidence of pulmonary aspiration and pneumonia, and showed better outcome in critically ill patients, compared with nasogastric tube feeding.
Figure 1-Nasointestinal versus nasogastric tube feeding in critically ill patients: the incidence of pulmonary aspiration and aspiration pneumonia
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