Nutrition in critical care · Route of enteral feeding
Early nasojejunal versus nasogastric nutrition in critical illness
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Early nasojejunal nutrition |
| Control | Continued nasogastric nutrition |
| Population | 181 mechanically ventilated patients with mildly elevated gastric residual volumes already receiving nasogastric nutrition |
| Follow-up | ICU stay |
| Primary endpoint | Energy delivery |
| Result | Nasojejunal placement was confirmed in 79 of 92 (87%) after a median 15 hours. The proportion of targeted energy delivered enterally was 72% with nasojejunal and 71% with nasogastric feeding (mean difference 1%). Ventilator-associated pneumonia did not differ, but gastrointestinal haemorrhage was more frequent with nasojejunal feeding, 13% versus 3% — the trial's only significant between-group difference. |
| Secondary endpoints | Ventilator-associated pneumonia, complications of tube placement |
In mechanically ventilated patients with mildly elevated gastric residual volumes and already receiving nasogastric nutrition, early nasojejunal nutrition did not increase energy delivery and was not associated with a reduction in ventilator-associated pneumonia.
The trial authors, in the published abstract
Removes the routine escalation to a technically demanding post-pyloric tube for mildly raised residuals — a problem Reignier 2013 then dissolved entirely by showing the residuals need not be measured.
Davies AR, Morrison SS, Bailey MJ, et al. A multicenter, randomized controlled trial comparing early nasojejunal with nasogastric nutrition in critical illness. Crit Care Med 2012 Aug;40(8):2342-8.