Post-pyloric Versus Gastric Tube Feeding For Preventing Complication, Improving Nutritional Outcomes And Prognosis In Mechanical Ventilation Adult Patients:a Meta-analysis

Objective Nutrition support is important for the critically ill patients.Nutrition support included enteral nutrition and parenteral nutrition，andenteral nutrition included nasogastric(NG) feedings and post-pyloricfeedings.This article is to study the effect of post-pyloric tube feedingcomparing with gastric tube feeding for preventing complication，improving nutritional outcomes and prognosis in mechanical ventilatedadult patients.Method The studies were identified through the medlinedatabase,pubmed,OVID,the Cochrane library, ChianInfo and ChineseBiomedical Database， bibliographies of primary and reviewarticles.Through duplicate independent review,we selected randomizedcontrolled trials published in English and Chinese literatures comparingpost-pyloric and gastric feeding in mechanical ventilation adult patients.Results Ten randomised controlled studies with a total of716 patients were included in this meta-analysis, in which353patients weretreated by post-pyloric tube feedings and others were treated by gastric tubefeedings. The meta-analysis of the randomised controlled trails showedthat comparing with the gastric tube feedings,use of post-pyloric tubefeedings can reduce the risk of VAP in the mechanical ventilated adultpatients(RR=0.44,95%CI（0.31，0.61），P＜0.00001)，but cannot reducethe risk of diarrhea（RR=0.70，95%CI(0.45,1.08)，P=0.11）.The resultsshowed that patients fed by post-pyloric tube received a significantlyhigher calorie per kilogram per day(MD=5.22，95%CI（3.01,7.42），P＜0.00001）,and also received a significantly higher proportion of their dailygoal caloric intake(MD=0.12，95%CI（0.11,0.14），P＜0.00001) thanpatients fed by gastric tube.What is more, patients receiving post-pylorictube feedings had shorter mechanical ventilation time than patients fed bygastric tube(MD=-4.09,95%CI（-6.40,-1.78），P=0.0005).However,therewere no difference in the ICU days（D=0.92,95%C（I-0.21,2.06），P=0.11）and hospital days（MD=-0.28,95%CI（-8.37,7.81），P=0.95）between thepatients received post-pyloric tube feedings or gastric tubefeedings.Motality were similar between the two groups(RR=0.98,95%CI（0.59,1.62），P=0.92).Conclusion Patients fed by post-pyloric tube had a lower risk ofVAP,received a significantly higher calorie per kilogram per day,received asignificantly higher proportion of their daily goal caloric intake,and also had shorter mechanical ventilation time than patients fed by gastrictube.But there was no difference in the ICU days,hospital days or motalityin the two groups.