The incidence of ventilator-associated pneumonia and success in nutrient delivery with gastric versus small intestinal feeding: A randomized clinicaltrial

Background: Enteral feeding provides nutrients for patients who require end otracheal tubes and mechanical ventilation. There is a presumed increase in the risk of ventilator-associated pneumonia (VAP) with tube feeding. This has stimulated the development of procedures for duodenal intubation and sm all intestinal (SI) feeding as primary prophylaxes to prevent VAP, Objective: To investigate the rate of VAP and adequacy of nutrient delivery with gastric (G) vs. SI feeding. Design: A prospective, randomized, controlled trial. Setting: A medical intensive care unit of a county hospital. Patients: A total of 44 endotracheally intubated, mechanically ventilated p atients requiring enteral nutrition, Intervention: Subjects were randomized to receive enteral nutrition via G o r SI feeding. Protocols directed the placement of the feeding tube and the infusion of enteral nutrition and defined the radiographic and clinical cri teria for a diagnosis of VAP. Measurements and Outcomes: The incidence of VAP and the adequacy of nutriti onal supplementation were prospectively followed. The relative risk of VAP with SI was 1.1 (95% confidence interval 0.96-2.44) compared with G, The SI group received a greater percentage of their caloric requirements (SI 69 /- 7% vs. G 47 +/- 7%, mean +/- SEM, p < .05), Mortality did not differ bet ween G (26 +/- 9%) and SI (24 +/- 10, p = .86). Conclusions: There is no clear difference in the incidence of VAP in SI com pared with G enteral nutrition. Patients given feeding into the SI do recei ve higher calorie and protein intakes.