Gastric/Jejunal Feeding: Nutritional Outcome and Pneumonia

Note: The Original PI was Mary McCarthy, MAJ(ret), USA.

Nutritional support is an essential component of multi-modality intensive care because nutritional debility may interact with a disease process to prolong recovery or impede survival. It is now recognized that patients with diseases associated with markedly increased caloric requirements can be successfully nourished with continuous administration of high-calorie, high-protein tube feedings. Nurses have an important role in support of nutritional therapies which includes initiating and maintaining therapy, evaluating response, and documenting and reporting complications. Enteral feeding is more economical and physiological than parenteral feeding; yet it may increase the risk of gastric colonization, aspiration, and pneumonia. It has long been accepted that colonization of the upper respiratory tract with enteric organisms plays a major role in the pathophysiology of hospital-acquired pneumonia. Nursing measures aimed at prevention of aspiration may reduce its frequency and severity but do not successfully prevent its occurrence. Few studies have examined the risks and benefits of jejunal versus gastric feeding but the assumption is made that jejunal feedings deliver greater amounts of formula because they do not require interruption as frequently as gastric feedings and jejunal feedings are associated with less gastric colonization with gram-negative bacilli, and a lower rate of pneumonia. The specific aims of this study are to: 1) compare nutritional outcomes between gastric and jejunal feedings, 2) compare rates of nosocomial pneumonia in gastric versus jejunal fed patients, and 3) compare two methods of jejunal tube insertion for accuracy and efficiency of placement. This study represents a replication effort of a randomized, prospective clinical study using a convenience sample from a military medical center. Nutritional outcome will be measured by daily caloric intake, nutritional assessment, biochemical parameters, and metabolic cart studies. Nosocomial pneumonia will be diagnosed by established clinical and micobiologic criteria. Characteristics of the three groups and outcomes will be compared using repeated measures of analysis of variance. Subset analysis will determine appropriate intervals for measurement. Maximizing nutritional outcomes while minimizing respiratory complications in the critically ill and injured results in shorter lengths of stay, decreased cost, reduced morbidity and mortality, and improved health and fitness for both the age-weakened geriatric patient and the war-torn soldier in his youth who must resume a combat posture on the battlefield.