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Intensive Care Medicine

, Volume 36, Issue 9, pp 1532–1539 | Cite as

Gastric versus transpyloric feeding in severe traumatic brain injury: a prospective, randomized trial

  • Jose Acosta-Escribano
  • Miguel Fernández-Vivas
  • Teodoro Grau Carmona
  • Juan Caturla-Such
  • Miguel Garcia-Martinez
  • Ainhoa Menendez-Mainer
  • Manuel Solera-Suarez
  • José Sanchez-Payá
Original

Abstract

Purpose

To evaluate the efficacy of transpyloric feeding (TPF) compared with gastric feeding (GF) with regard to the incidence of ventilator-associated pneumonia in severe traumatic brain injury patients (TBI).

Design and setting

Prospective, open-label, randomized study in an intensive care unit of a university hospital.

Patients

One hundred and four CHI adult patients admitted for TBI between April 2007 and December 2008. Patients were included within the first 24 h after ICU admission and were followed until discharge or 30 days after admission.

Intervention

Patients were randomized to TPF or GF groups. They received the same diet, with 25 kcal kg−1 day−1 of calculated energy requirements and a nitrogen intake of 0.2 g N kg−1 day−1. Primary outcome was the incidence of early and ventilatory-associated pneumonia. Secondary outcomes were enteral nutrition-related gastrointestinal complications (GIC), days on mechanical ventilation, length of ICU stay and hospital stay, and sequential organ failure assessment score (SOFA).

Results

The TPF group had a lower incidence of pneumonia, OR 0.3 (95% CI 0.1–0.7, P = 0.01). There were no significant differences in other nosocomial infections. The TPF group received higher amounts of diet compared to the GF group (92 vs. 84%, P < 0.01) and had lesser incidence of increased gastric residuals, OR 0.2 (95% CI 0.04–0.6, P = 0.003).

Conclusions

Enteral nutrition delivered through the transpyloric route reduces the incidence of overall and late pneumonia and improves nutritional efficacy in severe TBI patients.

Keywords

Nutrition Neurotrauma Mechanical ventilation Complications 

Abbreviations

BMI

Body mass index

CIPS

Clinical infection pulmonary score

GCS

Glasgow coma score

GIC

Enteral nutrition-related gastrointestinal complications

ICH

Intracranial hypertension

SOFA

Sequential organ failure assessment

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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Jose Acosta-Escribano
    • 1
  • Miguel Fernández-Vivas
    • 2
  • Teodoro Grau Carmona
    • 3
  • Juan Caturla-Such
    • 1
  • Miguel Garcia-Martinez
    • 1
  • Ainhoa Menendez-Mainer
    • 1
  • Manuel Solera-Suarez
    • 1
  • José Sanchez-Payá
    • 4
  1. 1.Intensive Care UnitHospital General Universitario de AlicanteAlicanteSpain
  2. 2.Intensive Care UnitHospital Universitario Virgen de la ArrixacaMurciaSpain
  3. 3.Intensive Care UnitHospital Universitario Doce de OctubreMadridSpain
  4. 4.Epidemiology UnitHospital General Universitario de AlicanteAlicanteSpain

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