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Title: Early jejunal feeding by bedside placement of a nasointestinal tube significantly improves nutritional status and reduces complications in critically ill patients versus enteral nutrition by a nasogastric tube.
Author: Wan B, Fu H, Yin J.
Journal: Asia Pac J Clin Nutr; 2015; 24(1):51-7. PubMed ID: 25740742.
Abstract:
BACKGROUND AND OBJECTIVE: Unguided nasojejunal feeding tube insertion success rates are low. Controversy persists about how to safely and efficiently perform enteral nutrition (EN) in critically ill patients. This study explores an innovative blind nasointestinal tube (NIT) insertion method and compares nasogastric and nasointestinal feeding. METHODS: Seventy critically ill patients admitted to the intensive care unit (ICU) were divided randomly into a nasogastric tube group (NGT; n=35) and an NIT group (NIT; n=35). After bedside NGT and blind-type NIT insertion, tube position was assessed and EN was started on day 1. Patients' nutritional status parameters, mechanical ventilation duration, average ICU stay, nutritional support costs, and feeding complications were compared. RESULTS: Pre-albumin and transferrin levels on days 7 and 14 were significantly higher in the NIT group than in the NGT group (p<0.01, p<0.05). Bloating, diarrhea, upper gastrointestinal bleeding, and liver damage did not differ significantly between groups (p>0.05). Interleukin-6 and tumor necrosis factor-α levels and APACHE II score were significantly lower in the NIT group than in the NGT group (p<0.01, p<0.05). Reflux and pneumonia incidences, mechanical ventilation duration, average ICU stay length, and nutritional support costs were significantly lower in the NIT group than in the NGT group (p<0.01). CONCLUSION: Blind bedside NIT insertion is convenient and its use can effectively improve nutritional status, reduce feeding complications, and decrease nutritional support costs of critically ill patients. 本研究探讨改良的盲插型鼻肠管的置入方法，并比较鼻肠管及鼻胃管进行肠内营养后患者的营养状态、炎症指标及肠内营养的费用及并发症发生率。入住 ICU的危重症患者70例随机分为鼻胃管组（NGT；n=35）和经鼻腔置入鼻肠管组（NIT；n=35）。比较了患者的营养相关指标、机械通气及ICU住院日、记录肠内营养并发症发生率及肠内营养费用等。第7、14天，NIT组的PA及TF水平明显高于NGT组（p<0.01，p<0.05）。两组间腹胀、腹泻、上消化道出血及肝功能损害无统计学差异，但反流及吸入性肺炎发生率、机械通气时间、ICU平均住院日和肠内营养支持费用，NIT组均明显低于NGT组（p<0.01）。IL-6和TNF- α水平及 APACHE II评分，NIT组显著低于NGT组（Day 7，p<0.01；Day 14， p<0.05）。使用新型鼻肠管并改良盲插方式，可以提高盲插成功率。更重要的是，及时使用鼻肠管肠内营养，可以显著改善重症患者的营养状况、炎症反应及肠内营养的支持费用和相关并发症。

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