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The Effect of Intermittent Nasogastric Feeding on Preventing Aspiration Pneumonia in Ventilated Critically Ill Patients

間歇性鼻胃管灌食法對預防急性重症呼吸器使用病人吸入性肺炎之成效

摘要


This randomized, controlled study employed two feeding protocols for 107 participants in two intensive care units (ICUs) of a medical center to investigate the efficacy of intermittent nasogastric (NG) feeding in preventing aspiration pneumonia in critically ill patients on ventilators. The participants were randomly assigned to receive continuous (51 patients) or intermittent (56 patients) feeding. The primary outcomes, including gastric emptiness index and pulmonary aspiration index, were examined on Day 0 and Day 7 of the intervention. In addition, patients were followed up to the 21st day to evaluate the secondary outcomes, which included length of stay (LOS) in the ICU and airway status. The results showed that the patients in the intermittent feeding group had a higher total intake volume at Day 7 (p=.000), had been extubated earlier at Day 21 (p=.002), and had a lower risk of aspiration pneumonia (odds ratios: 0.146, 95% CI=0.062-0.413, p=.000) than the patients in the control group. Participants being treated with a high dose of dopamine were 2.95 times more likely to get aspiration pneumonia than those receiving a low dose of dopamine (95% CI=1.076-8.107, p=.035). However, there was no significant difference between the two groups' LOS. The results of this study provide evidence that clinical caregivers may use to make better decisions in terms of feeding methods for critically ill patients.

並列摘要


This randomized, controlled study employed two feeding protocols for 107 participants in two intensive care units (ICUs) of a medical center to investigate the efficacy of intermittent nasogastric (NG) feeding in preventing aspiration pneumonia in critically ill patients on ventilators. The participants were randomly assigned to receive continuous (51 patients) or intermittent (56 patients) feeding. The primary outcomes, including gastric emptiness index and pulmonary aspiration index, were examined on Day 0 and Day 7 of the intervention. In addition, patients were followed up to the 21st day to evaluate the secondary outcomes, which included length of stay (LOS) in the ICU and airway status. The results showed that the patients in the intermittent feeding group had a higher total intake volume at Day 7 (p=.000), had been extubated earlier at Day 21 (p=.002), and had a lower risk of aspiration pneumonia (odds ratios: 0.146, 95% CI=0.062-0.413, p=.000) than the patients in the control group. Participants being treated with a high dose of dopamine were 2.95 times more likely to get aspiration pneumonia than those receiving a low dose of dopamine (95% CI=1.076-8.107, p=.035). However, there was no significant difference between the two groups' LOS. The results of this study provide evidence that clinical caregivers may use to make better decisions in terms of feeding methods for critically ill patients.

參考文獻


Bonten, M. J.,Gaillard, C. A.,van der Hulst, R.,de Leeuw, P. W.,van der Geest, S.,Stobberingh, E. E.(1996).Intermittent enteral feeding: The influence on respiratory and digestive tract colonization in mechanically ventilated intensive-care-unit patients.American Journal of Respiratory and Critical Care Medicine.154,394-399.
Booker, K. J.,Niedringhaus, L.,Eden, B.,Arnold, J. S.(2000).Comparison of 2 methods of managing gastric residual volumes with feeding tubes.American Journal of Critical Care.9(5),318-324.
Chandler, M. L.,Guilford, W. G.,Lawoko, C. R.(1996).Comparison of continuous versus intermittent enteral feeding in dogs.Journal of Veterinary Internal Medicine.10(3),133-138.
Chao, Y.(1998).Factors predisposing the development of gastrointestinal intolerances in ICU patients starting enteral nutrition and corresponding management.Nursing Research.6(6),461-474.
Collard, H. R.,Saint, S.,Matthay, M. A.(2003).Prevention of ventilator-associated pneumonia: An evidencebased systematic review.Annals of Internal Medicine.138(6),494-501.

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