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Table 1 Characteristics of included trials

From: Small bowel feeding and risk of pneumonia in adult critically ill patients: a systematic review and meta-analysis of randomized 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
 
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
  1. CDC, Centers for Disease Control; CPIS, Clinical Pulmonary Infection Score; CXR, chest x-ray; EMG, electromyography;NG, nasogastric; NJ, nasojejunal; ND, nasoduodenal; NR, not reported; VAP, ventilator-associated pneumonia; APACHE, acute physiology and chronic health evaluation; TBI, traumatic brain injury; WBC, white blood cell.
  2. OD, once daily; CT, computed tomography; OG, oro-gastric; BAL, bronchoalveolar lavage