Mixed
Post-pyloric (small bowel) tube feeding in critically ill adults reduces the rate of pneumonia compared to gastric (stomach) tube feeding, likely by bypassing gastric motility issues and reducing gastroesophageal reflux.
For critically ill adults needing tube feeding, placing the tube into the small intestine (post-pyloric) rather than the stomach significantly lowers the risk of developing pneumonia. This benefit comes at the cost of a more difficult initial tube placement procedure. However, it does not appear to shorten ICU stays, reduce mortality, or decrease the time on mechanical ventilation compared to standard stomach feeding. Use post-pyloric feeding if your institution has the expertise and it is feasible, particularly for patients at high risk of aspiration.
Moderate quality evidence suggests that post-pyloric feeding is associated with low rates of pneumonia compared with gastric tube feeding (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.51 to 0.84).
Why this rating
The evidence is rated 'Moderate' by GRADE, downgraded due to lack of blinding, but the effect size is significant and consistent.
Source
Post-pyloric versus gastric tube feeding for preventing pneumonia and improving nutritional outcomes in critically ill adults
Sana Alkhawaja et al. · Cochrane Database of Systematic Reviews · 2015
DOI 10.1002/14651858.cd008875.pub2
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