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Comparisons between intragastric and small intestinal delivery of enteral nutrition in the critically ill: a systematic review and meta-analysis

M Deane Adam12*, Dhaliwal Rupinder3, G Day Andrew3, J Ridley Emma4, R Davies Andrew4 and K Heyland Daren3

Author Affiliations

1 Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia

2 Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia

3 Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada

4 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia

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Critical Care 2013, 17:R125  doi:10.1186/cc12800

Published: 21 June 2013



The largest cohort of critically ill patients evaluating intragastric and small intestinal delivery of nutrients was recently reported. This systematic review included recent data to compare the effects of small bowel and intragastric delivery of enteral nutrients in adult critically ill patients.


This is a systematic review of all randomised controlled studies published between 1990 and March 2013 that reported the effects of the route of enteral feeding in the critically ill on clinically important outcomes.


Data from 15 level-2 studies were included. Small bowel feeding was associated with a reduced risk of pneumonia (Relative Risk, RR, small intestinal vs. intragastric: 0.75 (95% confidence interval 0.60 to 0.93); P = 0.01; I2 = 11%). The point estimate was similar when only studies using microbiological data were included. Duration of ventilation (weighted mean difference: -0.36 days (-2.02 to 1.30); P = 0.65; I2 = 42%), length of ICU stay (WMD: 0.49 days, (-1.36 to 2.33); P = 0.60; I2 = 81%) and mortality (RR 1.01 (0.83 to 1.24); P = 0.92; I2 = 0%) were unaffected by the route of feeding. While data were limited, and there was substantial statistical heterogeneity, there was significantly improved nutrient intake via the small intestinal route (% goal rate received: 11% (5 to 16%); P = 0.0004; I2 = 88%).


Use of small intestinal feeding may improve nutritional intake and reduce the incidence of ICU-acquired pneumonia. In unselected critically ill patients other clinically important outcomes were unaffected by the site of the feeding tube.