Table 1 Characteristics of included trials
Trial | Population | Interventions | Definition of pneumonia |
|---|---|---|---|
Montecalvo et al. 1992 [20] USA | Adult critically ill patients; mechanically ventilated patients in medical and surgical ICUs Mean age: 48 years Males: 60% Mean APACHE II score: 23 | NJ (n = 19) NG (n = 19) 12 French tube Endoscopic placement | New or persistent infiltrate on CXR for at least 5 days with any three of the following: a) purulent sputum with >25 WBC and <10 squamous epithelial cells on Gram stain and numerous bacteria b) purulent sputum with >25 WBC and <10 squamous epithelial cells on Gram stain and nosocomial or respiratory isolates on culture c) temperature > 38.6 ºC d) peripheral WBC >10,000 cells/mm3 |
Kortbeek et al. 1999 [21] Canada | Adult patients with major trauma and injury severity score ≥16 and mechanically ventilated for at least 48 hours Mean age: 34 years Male: 77.5% Mean APACHE II score: 18 Prokinetics not allowed for the first 24 hours | ND or OD (n = 37) NG or OG (n = 43) Fluoroscopic insertion | New infiltrate on radiograph (assessed by a blinded radiologist) of more than 48 hours' duration and at least two of the following: a) temperature >38.5 ºC or <35 ºC. b) blood WBC >10,000/cm3 or <3000/cm3. c) purulent sputum or isolation of pathogenic bacteria from endotracheal aspirate. A radiographic infiltrate and positive quantitative culture from BAL is also considered diagnostic of pneumonia |
Kearns et al. 2000 [22] USA | Adult patients admitted to medical ICU and mechanically ventilated Mean age: 51 years Male: 68% Mean APACHE II score: 21 All patients received H2 antagonists | Post pyloric (n = 21) NG (n = 23) Insertion was assisted using metoclopramide and tactile cues Location confirmed radioraphically (with or without barium) | Presence of a new infiltrate on a chest radiograph (assessed by 2 pulmonologists) in the presence of two of the following: a) WBC >10,000/mm3; b) temperature >38.5°C; and c) a positive glucose test or blue discoloration in the endotracheal secretions |
Boivin and Levy 2001 [29] | Adult patients who were admitted to ICU Mean age: 48 years Males: 45% Mean APACHE II score: 16.5 Mechanically ventilated: 79 (99%) | Post pyloric (n = 40) NG (n = 40) and erythromycin 200 mg iv every 8 hours for 96 hours Blind insertion/fluoroscopy in 4 patients | Pneumonia was not an outcome in this study |
Esparza et al. 2001 [24] USA | Adult patients in medical ICU Mean age: 47 years Male: 68% Mean APACHE II score: 16 All patients were mechanically ventilated except 1 patient in the post-pyloric feeding group and 2 patients in the gastric feeding group | ND (n = 27) NG (n = 27) Blind insertion or fluoroscopy (6 patients) Position confirmed with EMG and radiographs | Pneumonia was not an outcome in this study |
Day et al. 2001 [23] USA | Adult patients admitted to the neuro-ICU who are expected to receive enteral feeding for at least 72 hours Mean age: 57 years Male: 56% Mean APACHE III score: 47.8 | ND (n = 13) NG (n = 11) 10-French tube Blind insertion or fluoroscopy | Aspiration pneumonia was an outcome but no definition was provided |
Heyland et al. 2001 [25] Canada | Adult ICU patients expected to remain mechanically ventilated for > 72 hours Mean age: 59 years Male: 58% Mean APACHE II score: 22 | ND (n = 12) NG (n = 21) 12 French tubes Blind/endoscopic insertion Position confirmed radiologically with/without contrast | Pneumonia was not an outcome in this study |
Davies et al. 2002 [31] Australia | Adult ICU patients Mean age: 55 years Male: 70% Mean APACHE II score: 20 Mechanically ventilated patients: 90% | NJ (n = 34) NG (n = 39) Endoscopic insertion Location confirmed with contrast radiographs | Consensus conference definition. |
Montejo et al. 2002 [26] Spain | Adult mechanically ventilated patients in the ICU who are anticipated to require feeding >5 days Mean age: 57 years Male: 73% Mean APACHE II score: 18 | NJ (n = 50) NG (n = 51) Blind insertion/endoscopy/fluoroscopy/echography | CDC criteria for VAP, but no description of the criteria provided |
Neumann and DeLegge 2002 [27] USA | Adult patients in the ICU who are anticipated to require feeding >5 days Mean age: 57 years Male: 50% Mean APACHE II score: NR | Post pyloric (n = 30) NG (n = 30) 12 French tubes Blind insertion/fluoroscopy Location confirmed radiologically | Pneumonia not an outcome Clinically significant aspiration defined as new radiographic chest infiltrate that was empirically treated with antibiotics or the direct suctioning of feeding solution from oropharynx/airways |
Eatock et al. 2005 [32] Scotland | Adult patients with severe acute pancreatitis Median age: 60 years Male: 53% Median APACHE II score at day1: 11 Mechanically ventilated patients: 15 (31%) Patients admitted to ICU: 15 (31%) | NJ (n = 22) NG (n = 27) 7 or 8 French tubes Endoscopic insertion | Pneumonia was not an outcome in this study |
Kumar et al. 2006 [35] India | Adult patients with severe acute pancreatitis as defined by Atlanta criteria Admitted to ICU Mean age: 40 years Males: 83% Mean APACHE II score: 10 Respiratory failure: 19 (63%) | NJ (n = 14) NG (n = 16) Endoscopic insertion | Pneumonia was not reported as an outcome in this study |
Hsu et al. 2009 [33] Taiwan | Adult patient in medical ICU and mechanically ventilated Mean Age: 68 years Males: 70% Mean APACHE II score: 20 | ND (n = 59) NG (n = 62) 12 French tube Blind/endoscopic insertion | Not mentioned |
White et al. 009 [37] Australia | Adult mechanically ventilated patients in the ICU Median age: 52 years Males: 52% Median APACHE II score: 27 (APACHE II score were significantly different in both groups) | Post pyloric (n = 50) NG (n = 54) Blind insertion with erythromycin | Diagnosis of VAP was based on: new onset (after 48 hours) of fever, leukocytosis, new pulmonary infiltrates on chest radiograph, increased pulmonary secretions, and a clinical pulmonary infection score (CPIS) >6. |
Acosta-Escribano et al. 2010 [30] Spain | Adult patients with severe TBI requiring mechanical ventilation Mean age: 38 years Males: 86% Mean APACHE II score: 17 | NJ (n = 50) NG (n = 54) 12 French tube Radiologic placement | VAP defined as CPIS score >6 at 48 hours' post admission |
Zeng et al. 2010 [28] China | Adult patients with severe craniocerebral injury Mean age: 40 years Males: 63% Mean APACHE II score: NR | NJ (n = 20) NG (n = 20) | Pneumonia was not an outcome in this study |
Davies et al. 2012 [10] Australia and Canada | Adult >16 years old patients admitted to the ICU, mechanically ventilated >48 hours and receiving opioid infusion Mean age: 52 years Males: 74% Mean APACHE II score: 20 | NJ (n = 91) NG (n = 89) Spontaneously migrating frictional tube Location confirmed radiologically | Â |
Huang et al. 2012 [34] Taiwan | Adult patients in medical ICU, and requiring mechanical ventilation for more than 24 hours Mean age: 69 years Males: 71% Mean APACHE II score: 21 | ND (n = 50) NG (n = 51) 12 French tube Blind/endoscopic insertion Confirmation using pH measurement | VAP was diagnosed by two pulmonologists using a modified National Nosocomial Infections Surveillance system |
Singh et al. 2012 [36] India | Adult patients with severe acute pancreatitis as defined by: Atlanta criteria, APACHE II > 8 or CT severity index > 7 All patients were admitted to ICU. Mean age: 39 years Males: 68% Median APACHE II score: 8.2 | NJ (n = 39) NG (n = 39) Endoscopic placement | Pneumonia was not reported in this study |