A randomised controlled comparison of early post-pyloric versus early gastric feeding to meet nutritional targets in ventilated intensive care patients.

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Early enteral feeding is recognised as an important contributor to patient outcome in critically ill patients. This goal can be hard to achieve as patient often have difficulty tolerating nasogastric feeds. This is due to the tendency for seriously ill patients to develop a gastric ileus. One option is to begin intravenous feeding. However, parentral feeding is expensive and associated with a number of complications including sepsis. The insertion of post-pyloric tubes has been advocated for a number of years to overcome the problems with gastric feeding. Unfortunately, these tubes are difficult to place blindly, often requiring the assistance of gastroenterologists or radiologists. This often leads to delays instituting feeds, negating the benefits of early feeding. A number of centres have described protocols for placing small bowel tubes but with limited success. Recently, a simple technique with a relatively high success rate was described by a group of researchers. Our ICU has adopted their protocol and over the past few months have noted a success rate of nearly 100%. The implications are that by using this method, we are able to entrally feed virtually all our patients from day one. The aim of our study is to compare gastric and post-pyloric feeding in ventilated, critically ill patients. Our primary end-points include: time to insertion of feeding tube, time to reaching goal feeds and total nutrition received over ICU stay as proportion of calculated ideal. As part of the analysis we intend to compare complication rates between groups.

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