Duodenal versus gastric feeding in ventilated blunt trauma patients: A randomized controlled trial

Objective: To evaluate transpyloric feeds as they hale been proposed as a m eans of providing enteric nutrition more rapidly and minimizing morbidity i n ventilated trauma patients. Methods: Between July of 1994 and June of 1997, 80 adult ventilated trauma patients were enrolled in a randomized controlled trial of duodenal versus gastric feeds. Feeding was initiated within 72 hours of injury. Results: Forty-three patients received gastric feeds (G), and 37 patients r eceived duodenal feeds (D), Mean age was 34.7 +/- 15.7 years (G) and 33.6 /- 17.5 years (D); the difference in age was not significant (NS). Mean Inj ury Severity Score was 30.0 +/- 11 (G), 33.0 +/- 9.7 (D), NS. Mean Acute Ph ysiology and Chronic Health Evaluation (APACHE II) score was 18.0 +/- 6.0 ( G) and 18.0 +/- 7.4 (D), SS, Thirty-four of 43 patients were men (G) and 28 of 37 patients were men (D), SS, Use of narcotics and paralytics between t he two groups was not significantly different. Energy requirements were 1.4 times basal energy expenditure at 2,127 +/- 304 Kcal ie;, and 2,089 +/- 27 4 Kcal (D), NS, Intensive care unit length of stay Has a median of 7 days ( range, 3-32 days) (G) and 10 days (range, 3-24 days) (D), NS, Number of day s on a ventilator was a median of 5 days (range, 3-15 days) (G) and 9 days (range, 2-13 days) (D), NS. Hospital length of stay. was a median of 25 day s (range, 9-88 days) (G) and 30 days (range, 16-47 days) (D), NS, Recorded morbidity was not significantly different. Pneumonia rates were 42% (G) and 27% (D), NS, Time to tolerate full-strength feeds for 24 consecutive hours was 43.8 hours +/- 22.6 (G) and 34.3 hours +/- 7.1 (D), difference signifi cant atp = 0.02, Conclusion: Length of stay and ventilator days were not significantly diffe rent. A larger trial would be required to determine differences in the rate s of pneumonia <20%. Transpyloric-duodenal feeds significantly reduce the t ime required to achieve targeted enteric nutrition.