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Naso-intestinal versus gastric tube for enteral nutrition in patients undergoing mechanical ventilation: a systematic review and meta-analysis

Systematic Reviews volume 14, Article number: 13 (2025) Cite this article

Abstract

Background

A systematic appraisal of the comparative efficacy and safety profiles of naso-intestinal tube versus gastric tube feeding in the context of enteral nutrition for mechanically ventilated (MV) patients is imperative. Such an evaluation is essential to inform clinical practice, ensuring that the chosen method of nutritional support is both optimal and safe for this patient population.

Methods

We executed an exhaustive search across PubMed et al. databases to identify randomized controlled trials (RCTs) that scrutinize the role of naso-intestinal and gastric tubes for mechanically ventilated (MV) patients up to May 30, 2024. The process of study selection, quality assessment, and data extraction was conducted independently by two researchers. RevMan 5.3 software was used for meta-analysis.

Results

Our meta-analysis included 8 RCTs, published between 1992 and 2018, encompassing a total of 676 MV patients. The results indicated that naso-intestinal tube feeding, compared to gastric tube feeding, was associated with a significant reduction in the incidence of ventilator-associated pneumonia (VAP) [Risk Ratio (RR) = 0.69, 95% confidence interval (CI) (0.52, 0.92)] and gastric retention (RR = 0.11, 95% CI (0.04, 0.28)). No statistically significant differences were observed in the incidence of aspiration (RR = 0.93, 95% CI (0.35, 2.50)) vomiting (RR = 0.70, 95% CI (0.23, 2.08)), abdominal distension (RR = 0.87, 95% CI (0.29, 2.63)), or diarrhea (RR = 1.10, 95% CI (0.77, 1.55)).

Conclusions

The current evidence indicates that naso-intestinal tube feeding is efficacious in lowering the incidence of VAP and gastric retention among MV patients, without a corresponding escalation in the risk of adverse events, including aspiration, vomiting, abdominal distension, and diarrhea. These insights significantly augment the existing corpus of knowledge pertaining to the optimization of enteral nutrition strategies for patients on mechanical ventilation.

Peer Review reports

Background

Ventilator-associated pneumonia (VAP) is a pulmonary infection that occurs 48 h after mechanical ventilation (MV), or within 48 h of extubation [1]. At present, the morbidity and mortality of VAP are relatively high, it’s been reported that the incidence of VAP is 6 ~ 52%, and the mortality rate is 14 ~ 50% [2, 3]. Patients on MV frequently exhibit varying levels of consciousness impairment, precluding the ability to consume food autonomously. Concurrently, these individuals are often in a state of pronounced hypermetabolism, characterized by an elevated metabolic rate that can significantly impact their nutritional status and overall health [4, 5]. It has been reported that the provision of timely and adequate nutritional support, with a particular emphasis on enteral nutrition, is crucial for sustaining metabolic homeostasis, bolstering immune function, and mitigating the risk of pulmonary infections [6,7,8]. Therefore, enteral nutrition management is very important for the prognosis of MV patients.

At present, the commonly used clinical tube feeding methods for enteral nutrition are gastric tube and naso-intestinal tube feeding [9]. Indwelling gastric tube is one of the basic nursing operation techniques used in surgical gastrointestinal or acute abdominal surgery [10]. It is widely used in clinical practice, but the incidence of reflux and aspiration of gastric contents in patients is also high, which is up to 88.9% [11]. It’s been reported that trans-gastric tube enteral nutrition is an independent risk factor for VAP in intensive care unit (ICU) patients [12, 13]. The shorter the time the indwelling gastric tube is in place, the lower the incidence of VAP [14]. Naso-intestinal tube placement refers to the method of indirect or direct delivery of the naso-intestinal tube into the duodenum or upper jejunum [15]. In comparison to gastric tube feeding, the placement of naso-intestinal tubes is associated with a diminished risk of aspiration and a lower incidence of VAP. Furthermore, this approach has been demonstrated to ameliorate the nutritional indices of patients requiring mechanical ventilation, concurrently reducing the duration of mechanical ventilation and the frequency of intensive care unit (ICU) admissions [16, 17]. Nevertheless, previous studies [18, 19] have highlighted that in critically ill patients with modestly elevated gastric residual volumes, naso-intestinal enteral nutrition may confer benefits such as a reduced incidence of ventilator-associated pneumonia (VAP) and enhanced caloric intake. However, it also raises concerns regarding the potential for increased gastrointestinal bleeding risk. The efficacy and safety of naso-intestinal versus gastric tubes for enteral nutrition in MV patients are subjects of ongoing debate, with existing literature presenting conflicting findings. In light of this, the objective of the present study is to systematically assess the comparative effectiveness and safety of enteral nutrition delivered through naso-intestinal and gastric tubes in MV patients. Our aim is to contribute robust evidence to inform clinical decision-making and enhance the management and nursing practices associated with enteral nutrition in the context of mechanical ventilation.

Methods

We performed and reported this systematic review and meta-analysis in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [20].

Inclusion and exclusion criteria

The inclusion criteria for this meta-analysis were ① study population: adult MV patients age ≥ 18 years old; ② intervention: the experimental group received naso-intestinal enteral nutrition, and the control group received nasogastric enteral nutrition; ③ study type: randomized controlled trial (RCT) design reported in English or Chinese; outcome indicators: the main outcome indicators included the incidence of VAP, aspiration, gastric retention, vomiting, abdominal distention and diarrhea. The exclusion criteria for this meta-analysis were ① the included patients received gastrostomy and intestinal fistula treatment; ② the relevant research data or the full text of the research could not be obtained.

Research strategy

We used a combination of free words and subject terms to search CINAHL, PubMed, the Cochrane Library, Web of Science, British Nursing Index, Wanfang, and China National Knowledge Infrastructure (CNKI) databases for related reports on the effectiveness and safety of the naso-intestinal tube and gastric tube application in MV patients. The search strategy utilized in this meta-analysis was as delineated below: (“mechanical ventilation” OR “mechanically ventilated” OR “ventilation” OR “artificial airway”) AND (“nasoenteral tube” OR “gastrointestinal feed” OR “nasogastric tube” OR “nasogastric feed” OR “nasointestinal” OR “enteral nutrition”). We searched the clinical trial database (Clinical Trials.gov) for unpublished publications on the effectiveness and safety of the application of naso-intestinal tubes and gastrointestinal nutrition in MV patients. The search language of this meta-analysis was not limited, and the search time limit was from the establishment of the database to May 30, 2024. In the execution of this meta-analysis, a meticulous literature search was performed by two researchers who adhered to the search strategy. This approach was meticulously designed to uphold the highest standards of methodological rigor and to ensure the precision and accuracy of the search process. At the same time, we reviewed and searched the references of identified RCTs and associated reviews to avoid missed report detection.

Literature screening and data extraction

Two researchers independently screened the literature according to the inclusion and exclusion criteria of the literature. Disparities regarding the inclusion of literature in this meta-analysis were amicably resolved through collaborative deliberation between the two researchers. In instances where consensus could not be reached following initial discussions, the matter was escalated to include the input of a third researcher, thereby facilitating a more comprehensive and objective resolution. Data extraction was performed by two researchers independently extracting the data and information included in the study based on the pre-designed literature data extraction table. After extraction, the two researchers reviewed the data with each other. After the literature screening is completed, the data would be extracted, and for the studies with the lack of data, we would contact the corresponding author for more data. The data extracted in this meta-analysis included the research area, sample size, basic data of the study population, intervention measures, and outcome indicators.

Risk of bias evaluation

Two researchers conducted an independent assessment and grading of the methodological quality of the RCTs included in this study, adhering to the evaluation criteria outlined in the Cochrane Evaluation Manual 5.1.0 [21]. The assessment encompassed various aspects, including the generation of random sequences, concealment of allocation, blinding of participants and researchers, outcome assessor blinding, completeness of outcome data, potential for selective reporting, and the presence of other biases. Each criterion was evaluated and categorized as presenting a “high risk of bias,” “low risk of bias,” or being “unclear.”

Statistical method

We used ReVman5.3 software to perform a meta-analysis. We used risk ratio (RR) and 95% confidence interval (CI) for dichotomous outcomes. We have applied both random effects and fixed effects models to all our results. The presence of publication bias was meticulously assessed through the utilization of funnel plots, with the degree of asymmetry therein quantitatively evaluated via the execution of an Egger regression analysis. To ascertain the robustness of the research findings, a sensitivity analysis was meticulously conducted by sequentially excluding individual research datasets, thereby scrutinizing the stability of the resultant outcomes. P < 0.05 indicated that the difference was statistically significant.

Results

Study selection

As presented in Fig. 1, we initially identified the 155 potentially relevant studies in the first search. Of these identified articles, 18 studies were excluded as duplicates. After reviewing the titles and abstracts of the 137 remaining studies, the full texts of 56 studies were retrieved. Among them, 48 studies were excluded for failure to meet the inclusion criteria. Finally, 8 RCTs were included in this present meta-analysis [22,23,24,25,26,27,28,29].

Fig. 1
figure 1

PRISMA flow diagram of study selection

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The characteristics and quality of included RCTs

Of the 8 included RCTs [22,23,24,25,26,27,28,29], a total of 676 MV patients were included, specifically with 329 patients receiving the naso-intestinal tube treatment, and 347 patients receiving the gastric tube treatment. The included studies were reported from Spain, China, Brazil, Canada, USA and Australia. The average age of the patients enrolled in the included studies was about 55 years old, and there were more male patients than female patients. Most studies have reported the patient's APACHE II score, and VAP is the most commonly reported result of each study. The characteristics of included RCTs are indicated in Table 1.

Table 1 The characteristics of included RCTs
Full size table

The quality of included RCTs is presented in Figs. 2 and 3. In this systematic review, all RCTs claimed to implement randomization, and they offered a comprehensive description of the methods used for generating randomization sequences. However, only a single RCT within our dataset explicitly documented the process of allocation concealment, which is a critical component of trial design to prevent selection bias. Moreover, none of the studies provided specific information regarding blinding procedures, such as the methods employed to mask the intervention allocation from both participants and researchers, which could potentially introduce performance and detection biases. Upon meticulous review, we found no evidence of selective reporting or other significant biases within the eight RCTs that were included in this systematic review.

Fig. 2
figure 2

Risk of bias graph

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Fig. 3
figure 3

Risk of bias summary

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Meta-analysis

The incidence of VAP

Six RCTs reported the incidence of VAP [22,23,24,25,26,27]. The statistical heterogeneity among the studies was small (P = 0.13, I2 = 41%), and the fixed effects model was used for analysis. Meta-analysis showed that compared with gastric tube feeding, naso-intestinal tube feeding was beneficial in reducing the incidence of VAP in MV patients [RR = 0.69, 95%CI (0.52, 0.92), P = 0.01], see Fig. 4A.

Fig. 4
figure 4

The forest plots for synthesized outcomes of included RCTs

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The incidence of aspiration

Three studies reported the number of people with aspiration [22, 24, 29]. The statistical heterogeneity among the studies was small (P = 0.33, I2 = 9%), and the fixed effects model was used for analysis. The results of the meta-analysis showed that there was no statistically significant difference in the incidence of aspiration between the naso-intestinal tube and gastric tube feeding [RR = 0.93, 95%CI (0.35, 2.50), P = 0.88], see Fig. 4B.

Incidence of abdominal distention

Two studies reported the number of people with abdominal distension [22, 26]. The statistical heterogeneity between the studies was small (P = 0.28, I2 = 15%), and the fixed-effects model was used for meta-analysis. The results of the meta-analysis showed that the incidence of abdominal distension between the naso-intestinal tube and gastric tube feeding was not statistically different [RR = 0.87, 95%CI (0.29, 2.63), P = 0.81], see Fig. 4C.

The incidence of gastric retention Three studies reported the number of people with gastric retention [22, 25, 26]. The statistical heterogeneity among the studies was small (P = 0.32, I2 = 13%), and the fixed-effects model was used for analysis. Meta-analysis results showed that compared with gastric tube feeding, naso-intestinal tube feeding could reduce the incidence of gastric retention [RR = 0.11, 95%CI (0.04, 0.28), P < 0.001], see Fig. 5A.

Fig. 5
figure 5

The forest plots for synthesized outcomes of included RCTs

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The incidence of vomiting

Four studies reported the number of people for vomiting [23, 25,26,27]. The statistical heterogeneity among the studies was large (P = 0.04, I2 = 63%), and the random effects model was used for analysis. The results of the meta-analysis showed that there was no statistically significant difference in the incidence of vomiting between the naso-intestinal tube and gastric tube feeding [RR = 0.70, 95%CI (0.23, 2.08), P = 0.52], see Fig. 5B.

The incidence of diarrhea

Five studies reported the number of people with diarrhea [22, 23, 25,26,27]. The statistical heterogeneity among the studies was small (P = 0.53, I2 = 0%), and the fixed effects model was used for analysis. The results of the meta-analysis showed that there was no statistically significant difference in the incidence of diarrhea between the naso-intestinal tube and gastric tube feeding [RR = 1.10, 95%CI (0.77, 1.55), P = 0.61], see Fig. 5C.

We have employed both random effects and fixed effects models in our analysis and observed no significant alterations in the statistical outcomes. Furthermore, to conduct a sensitivity analysis for various clinical outcome indicators, we sequentially excluded individual research datasets. The results of this sensitivity analysis consistently demonstrated that the overall effects were robust and stable.

Publication bias

In our endeavor to assess publication bias, we employed funnel plots for visual representation, as depicted in Fig. 6. The symmetrical distribution of the plotted points within the funnel plots suggested a relatively uniform dispersion, indicative of a low likelihood of publication bias. This inference was further corroborated by the results of the Egger regression tests, where no significant evidence of publication bias was observed (all P > 0.05).

Fig. 6
figure 6

The funnel plots for synthesized outcomes of included RCTs

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Discussions

Enteral nutrition support through the nasogastric tube plays an important role in clinical treatment. A nasogastric tube has been used to reduce the blood pressure of the gastrointestinal tract and drain the gastric contents for relevant judgment and analysis [30, 31]. Currently, the practice of indwelling nasogastric tube feeding stands as a pivotal therapeutic intervention for patients afflicted with coma or compromised swallowing function [32]. In the context of patients with MV, and particularly for those who are undergoing gastric-related surgical procedures, the occurrence of gastrointestinal complications, including gastric ulceration, gastric retention, and gastroesophageal reflux, is likely to exert a significant influence on the digestive capabilities of the stomach and may attenuate intestinal function. This underscores the importance of vigilant monitoring and management of these conditions to mitigate their impact on the overall gastrointestinal health of the patients [33]. Long-term feeding causes complications such as vocal cord paralysis, which may further worsen the condition [34, 35]. The results of this meta-analysis have shown that compared with gastric tube enteral nutrition, naso-intestinal enteral nutrition is beneficial in reducing the incidence of VAP and gastric retention in MV patients, and it does not increase the incidence of aspiration, vomiting, abdominal distension, and diarrhea.

VAP represents the most prevalent and perilous nosocomial infection encountered by patients on MV. The onset of VAP has been associated with a range of detrimental outcomes, including the prolongation of ventilator dependency, an extended duration of hospital stays, and an escalation in the incidence of complications. These factors collectively contribute to the heightened morbidity and mortality associated with VAP, underscoring the imperative for stringent preventive measures and timely therapeutic interventions [36]. The results of this study suggest that enteral nutrition via naso-intestinal tube can reduce the incidence of VAP in MV patients, while previous studies have shown that there is no statistically significant difference in the incidence of pneumonia in critically ill patients [37, 38]. The observed discrepancies may stem from the inclusion of patients in the study who have not been subjected to MV, whereas the study’s population exclusively comprises MV patients. Additionally, the variability in diagnostic criteria for ventilator-associated pneumonia VAP could contribute to these inconsistencies. Patients on MV are particularly susceptible to gastroesophageal reflux and aspiration events, which can be attributed to the diminished capacity of the esophagus to clear refluxed contents and the frequent administration of substantial sedative doses [39]. Gastric reflux and aspiration are recognized as significant etiological factors in the development of VAP. Furthermore, the assessment of a patient’s gastrointestinal motility and tolerance to enteral nutrition is of paramount importance [40]. Monitoring residual gastric volume serves as a critical tool in evaluating the risk of reflux, aspiration, and consequently, VAP. This approach facilitates a more nuanced understanding of the patient's condition and allows for the implementation of targeted interventions to mitigate the risk of these complications.

The results of this study show that enteral nutrition via naso-intestinal tube can reduce the incidence of gastric retention. Previous studies have pointed out that naso-intestinal enteral nutrition is particularly suitable for critically ill patients with low Glasgow scores and a high risk of gastric retention [41, 42]. However, the absence of standardized diagnostic criteria for gastric retention across the studies under review has led to a wide range of reported critical values for gastric residual volume, spanning from 100 to 500 mL. The literature is notably sparse in terms of studies that directly compare the impact of the two enteral nutrition modalities on gastric retention in patients undergoing MV. Consequently, the findings in this area require further substantiation through additional empirical evidence in future research endeavors. This will be essential to establish more definitive guidelines and to enhance clinical decision-making regarding the management of gastric retention in the context of MV. Given the precarious health status of MV patients, who frequently exhibit impaired consciousness and dysphagia, their overall nutritional status tends to be compromised [10, 43, 44]. The body is in a state of high metabolism and high decomposition of negative nitrogen balance for a long time, and adequate nutritional support is required to reduce the occurrence of complications and improve the prognosis [45, 46]. It has been reported that the daily calorie intake of critically ill patients through enteral nutrition only reaches 50% to 64% of the target calories [47]. In critically ill patients requiring MV, inadequate nutritional intake is associated with an increased likelihood of prolonged ICU stays and extended durations of mechanical ventilation. This scenario can exacerbate the patient's condition, thereby heightening the susceptibility to complications, including the development of infections. The ramifications of suboptimal nutrition are far-reaching, emphasizing the critical importance of ensuring adequate nutritional support as a cornerstone of care in this vulnerable patient population [48]. Studies [49, 50] have shown that the incidence of aspiration in critically ill patients is 6.67 ~ 19.78%, and the incidence of diarrhea is 6.67 ~ 28.57%. The results of this study show that there is no significant difference in the incidence of aspiration, vomiting, abdominal distension, and diarrhea between naso-intestinal and gastric enteral nutrition, indicating that naso-intestinal enteral nutrition may not increase the incidence of the above complications in MV patients and it has a certain degree of safety [51].

This meta-analysis has certain limitations that should be considered. Firstly, although all the studies included in our analysis are RCTs, a subset of these studies failed to detail the methods of random sequence generation and allocation concealment. Given the inherent nature of the interventional measures, the majority of the studies did not implement blinding of either the research participants or the investigators. Secondly, the diagnostic criteria of clinical outcome indicators in the included studies were not uniform, and some studies did not clearly report the specific diagnostic criteria, body position, and the risk for aspiration, which might have a certain impact on the judgment of the results. Additionally, the methodologies utilized for outcome assessment in some of the included RCTs are not explicitly detailed. Certain clinical outcome measures, including aspiration, abdominal distension, and daily caloric intake, were only reported in two RCTs each. Due to the constraints imposed by the available data, we were unable to conduct subgroup analyses or meta-regression to ascertain the sources of heterogeneity. Furthermore, the scope of our literature search was confined to studies published in English and Chinese, precluding the inclusion of research reported in other languages within this meta-analysis. Our study encompasses RCTs from Europe and the United States, where race is often considered a significant factor. However, due to limitations in the reported data, we were unable to perform subgroup analyses based on racial demographics. Hence, the potential of naso-intestinal tubes to facilitate earlier attainment of targeted nutritional goals and to enhance overall caloric intake merits further investigation in future studies. This inquiry will be pivotal in elucidating the comparative advantages and clinical implications of naso-intestinal tube feeding in the context of enteral nutrition support.

Conclusions

In conclusion, the findings of this study have revealed that enteral nutrition administered through naso-intestinal tubes is associated with a reduced incidence of VAP and gastric retention in patients on mechanical ventilation MV. Furthermore, this method of nutrition delivery has been shown to enhance patient nutritional intake without a concomitant increase in the prevalence of adverse events such as aspiration, vomiting, abdominal distension, and diarrhea. For MV patients who exhibit a predisposition to gastric retention, the use of naso-intestinal tubes for enteral nutrition may be a viable consideration. It is anticipated that future studies will conduct more comprehensive comparative analyses of the clinical efficacy of various enteral nutrition approaches in MV patients. Such research will be instrumental in furnishing a robust evidence base to inform clinical practice, guiding the selection of the most efficacious tube feeding strategies aimed at preventing or mitigating the complications associated with enteral nutrition.

Data availability

All data generated or analyzed during this study are included in this published article.

Abbreviations

MV:

Mechanical ventilation

RCT:

Randomized controlled trial

VAP:

Ventilator-associated pneumonia

References

  1. Maes M, Higginson E, Pereira-Dias J, Curran MD, Parmar S, Khokhar F, Cuchet-Lourenco D, Lux J, Sharma-Hajela S, Ravenhill B, et al. Ventilator-associated pneumonia in critically ill patients with COVID-19. Crit Care. 2021;25(1):25.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Wicky PH, Niedermann MS, Timsit JF. Ventilator-associated pneumonia in the era of COVID-19 pandemic: How common and what is the impact? Crit Care. 2021;25(1):153.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Nanao T, Nishizawa H, Fujimoto J, Ogawa T. Additional medical costs associated with ventilator-associated pneumonia in an intensive care unit in Japan. Am J Infect Control. 2021;49(3):340–4.

    Article  PubMed  Google Scholar 

  4. Launey Y, Asehnoune K, Lasocki S, Dahyot-Fizelier C, Huet O, Le Pabic E, Malejac B, Seguin P, AtlanRea G. Risk factors for ventilator-associated pneumonia due to Staphylococcus aureus in patients with severe brain injury: a multicentre retrospective cohort study. Anaesth Crit Care Pain Med. 2021;40(1):100785.

    Article  PubMed  Google Scholar 

  5. Staub LJ, Biscaro RRM, Maurici R. Emergence of alveolar consolidations in serial lung ultrasound and diagnosis of ventilator-associated pneumonia. J Intensive Care Med. 2021;36(3):304–12.

    Article  PubMed  Google Scholar 

  6. Pen DL, Yan GF, He LY, Yan WL, Chen WM, Liu J, Ying JY, Wang CQ, Lu GP. The role of bacterial colonization of ventilator circuit in development of ventilator-associated pneumonia: a prospective observational cohort study. Clin Microbiol Infect. 2021;27(3):467.e1-467.e7.

    Article  PubMed  Google Scholar 

  7. Manchal N, Siriwardena M, Hay K, Shekar K, McNamara JF. Assessment of the clinical pulmonary infection scores for prediction of ventilator associated pneumonia in patients with out of hospital cardiac arrest. Infect Dis Health. 2021;26(1):48–54.

    Article  PubMed  Google Scholar 

  8. Martindale R, Patel JJ, Taylor B, Arabi YM, Warren M, McClave SA. Nutrition therapy in critically ill patients with coronavirus disease 2019. JPEN J Parenter Enteral Nutr. 2020;44(7):1174–84.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Liu Y, Wang Y, Zhang B, Wang J, Sun L, Xiao Q. Gastric-tube versus post-pyloric feeding in critical patients: a systematic review and meta-analysis of pulmonary aspiration- and nutrition-related outcomes. Eur J Clin Nutr. 2021;75(9):1337–48.

    Article  PubMed  Google Scholar 

  10. Wang WN, Wang CY, Hsu CY, Fu PK. Comparison of feeding efficiency and hospital mortality between small bowel and nasogastric tube feeding in critically ill patients at high nutritional risk. Nutrients. 2020;12(7):2009.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Shi J, Liu R. Investigation of nasal feeding reflux aspiration in elderly coma patients in neurosurgery and analysis of its risk factors. Geriatrics and Health Care. 2023;29(6):1253–7.

    Google Scholar 

  12. Jacobson LE, Olayan M, Williams JM, Schultz JF, Wise HM, Singh A, Saxe JM, Benjamin R, Emery M, Vilem H, et al. Feasibility and safety of a novel electromagnetic device for small-bore feeding tube placement. Trauma Surg Acute Care Open. 2019;4(1):e000330.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Tatsumi H. Enteral tolerance in critically ill patients. J Intensive Care. 2019;7:30.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wang WN, Yang MF, Wang CY, Hsu CY, Lee BJ, Fu PK. Optimal time and target for evaluating energy delivery after adjuvant feeding with small bowel enteral nutrition in critically Ill patients at high nutrition risk. Nutrients. 2019;11(3):645.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Huang HH, Chang SJ, Hsu CW, Chang TM, Kang SP, Liu MY. Severity of illness influences the efficacy of enteral feeding route on clinical outcomes in patients with critical illness. J Acad Nutr Diet. 2012;112(8):1138–46.

    Article  PubMed  Google Scholar 

  16. Davies AR, Morrison SS, Bailey MJ, Bellomo R, Cooper DJ, Doig GS, Finfer SR, Heyland DK, Investigators ES, Group ACT. A multicenter, randomized controlled trial comparing early nasojejunal with nasogastric nutrition in critical illness. Crit Care Med. 2012;40(8):2342–8.

    Article  Google Scholar 

  17. Chen F, Xu C, Zhang C. Effect of indwelling nasointestinal tube for enteral nutrition support in patients with severe craniocerebral trauma undergoing mechanical ventilation. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018;30(1):57–60.

    PubMed  Google Scholar 

  18. Bassetti M, Taramasso L, Giacobbe DR, Pelosi P. Management of ventilator-associated pneumonia: epidemiology, diagnosis and antimicrobial therapy. Expert Rev Anti Infect Ther. 2012;10(5):585–96.

    Article  PubMed  CAS  Google Scholar 

  19. Jinyan W, Shunfang Z, Yanni W. Meta-analysis of the comparison of the effectiveness and safety of enteral nutrition between naso-intestinal tube and gastric tube in mechanically ventilated patients. Nurs Res. 2020;10(2):219–26.

    Google Scholar 

  20. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

    Article  Google Scholar 

  21. Sterne JAC, Savovic J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng HY, Corbett MS, Eldridge SM, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.

    Article  PubMed  Google Scholar 

  22. Acosta-Escribano J, Fernandez-Vivas M, Grau Carmona T, Caturla-Such J, Garcia-Martinez M, Menendez-Mainer A, Solera-Suarez M, Sanchez-Paya J. Gastric versus transpyloric feeding in severe traumatic brain injury: a prospective, randomized trial. Intensive Care Med. 2010;36(9):1532–9.

    Article  PubMed  Google Scholar 

  23. Friedman G, Flavia Couto CL, Becker M. Randomized study to compare nasojejunal with nasogastric nutrition in critically ill patients without prior evidence of altered gastric emptying. Indian J Crit Care Med. 2015;19(2):71–5.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kearns PJ, Chin D, Mueller L, Wallace K, Jensen WA, Kirsch CM. The incidence of ventilator-associated pneumonia and success in nutrient delivery with gastric versus small intestinal feeding: a randomized clinical trial. Crit Care Med. 2000;28(6):1742–6.

    Article  PubMed  CAS  Google Scholar 

  25. Montecalvo MA, Steger KA, Farber HW, Smith BF, Dennis RC, Fitzpatrick GF, Pollack SD, Korsberg TZ, Birkett DH, Hirsch EF, et al. Nutritional outcome and pneumonia in critical care patients randomized to gastric versus jejunal tube feedings. The Critical Care Research Team. Crit Care Med. 1992;20(10):1377–87.

    Article  PubMed  CAS  Google Scholar 

  26. Montejo JC, Grau T, Acosta J, Ruiz-Santana S, Planas M, Garcia-De-Lorenzo A, Mesejo A, Cervera M, Sanchez-Alvarez C, Nunez-Ruiz R, et al. Multicenter, prospective, randomized, single-blind study comparing the efficacy and gastrointestinal complications of early jejunal feeding with early gastric feeding in critically ill patients. Crit Care Med. 2002;30(4):796–800.

    Article  PubMed  Google Scholar 

  27. Wan B, Fu H, Yin J. Early jejunal feeding by bedside placement of a nasointestinal tube significantly improves nutritional status and reduces complications in critically ill patients versus enteral nutrition by a nasogastric tube. Asia Pac J Clin Nutr. 2015;24(1):51–7.

    PubMed  Google Scholar 

  28. White H, Sosnowski K, Tran K, Reeves A, Jones M. A randomised controlled comparison of early post-pyloric versus early gastric feeding to meet nutritional targets in ventilated intensive care patients. Crit Care. 2009;13(6):R187.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ding X. Comparison of the effect of blind insertion of nasal jejunal tube and nasogastric tube nutritional support on patients with severe head injury. Chinese Journal of Modern Nursing. 2018;24(9):1067–701.

    Google Scholar 

  30. Fan M, Chang L, Zhou H. Construction of nutritional nursing program for stroke patients with nasal feeding during gastric tube extraction. J Nurs Educ. 2022;37(4):5–8.

    Google Scholar 

  31. Wang Y, Liu M, Jiang H. Interpretation of nutrition therapy pathway guidelines for chinese adult patients: nasogastric Tube. Journal of tumor Metabolism and Nutrition. 2022;9(5):5–8.

    Google Scholar 

  32. Schlein K. Gastric versus small bowel feeding in critically ill adults. Nutr Clin Pract. 2016;31(4):514–22.

    Article  PubMed  Google Scholar 

  33. Niu C, Guo W, Gu W. Epidemiological study on the status of nutrition-support therapies by emergency physicians in China. Emerg Med Int. 2019;2019:7657436.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Ge W, Wei W, Shuang P, Yan-Xia Z, Ling L. Nasointestinal Tube in Mechanical Ventilation Patients is More Advantageous. Open Med (Wars). 2019;14:426–30.

    Article  PubMed  Google Scholar 

  35. Zhang Q, Sun JH, Liu JT, Wang XT, Liu DW. Placement of a jejunal feeding tube via an ultrasound-guided antral progressive water injection method. Chin Med J (Engl). 2018;131(14):1680–5.

    Article  PubMed  Google Scholar 

  36. Jakob SM, Butikofer L, Berger D, Coslovsky M, Takala J. A randomized controlled pilot study to evaluate the effect of an enteral formulation designed to improve gastrointestinal tolerance in the critically ill patient-the SPIRIT trial. Crit Care. 2017;21(1):140.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Xinyu M. Comparison of the incidence of VAP and related indicators in patients with mechanical ventilation fed by naso-intestinal tube and nasogastric tube for enteral nutrition support. Chin J Prev Med. 2020;38(8):71–3.

    Google Scholar 

  38. Lili C, Linli Z, Xiaoyan D. Application of two enteral nutrition approaches and nursing care in elderly patients with mechanical ventilation in ICU. Journal of Practical Clinical Medicine. 2014;21(18):36–9.

    Google Scholar 

  39. Yang Y, Wu L, Fang X. Effect of aspiration risk assessment combined with Johns Hopkins evidence-based nursing on aspiration and nutritional status of ICU elderly patients with nasal feeding. Nurs Res. 2022;36(5):5–9.

    CAS  Google Scholar 

  40. Jing Y, Wu Y. Development and verification of risk prediction model for aspiration in patients with nasal feeding. General practice Clinical and Educatio. 2023;21(12):1131–4.

    Google Scholar 

  41. Shi Y, Zhang XP, Qin H, Yu YJ. Naso-intestinal tube is more effective in treating postoperative ileus than naso-gastric tube in elderly colorectal cancer patients. Int J Colorectal Dis. 2017;32(7):1047–50.

    Article  PubMed  Google Scholar 

  42. Piciucchi M, Merola E, Marignani M, Signoretti M, Valente R, Cocomello L, Baccini F, Panzuto F, Capurso G, Delle Fave G. Nasogastric or nasointestinal feeding in severe acute pancreatitis. World J Gastroenterol. 2010;16(29):3692–6.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Park JW, Park KD, Kim TH, Lee JY, Lim OK, Lee JK, Choi C. Comparison of tube feeding in stroke patients: nasogastric tube feeding versus oroesophageal tube feeding-A pilot study. Medicine (Baltimore). 2019;98(30):e16472.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Ojo O, Keaveney E, Wang XH, Feng P. The effect of enteral tube feeding on patients’ health-related quality of life: a systematic review. Nutrients. 2019;11(5):1046.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Lee YF, Hsu TW, Liang CS, Yeh TC, Chen TY, Chen NC, Chu CS. The efficacy and safety of tube feeding in advanced dementia patients: a systemic review and meta-analysis study. J Am Med Dir Assoc. 2021;22(2):357–63.

    Article  PubMed  Google Scholar 

  46. Dutta AK, Goel A, Kirubakaran R, Chacko A, Tharyan P. Nasogastric versus nasojejunal tube feeding for severe acute pancreatitis. Cochrane Database Syst Rev. 2020;3:CD010582.

    PubMed  Google Scholar 

  47. Badran AT, Hashish M, Ali A, Shokeir M, Shabaan A. Nasogastric versus orogastric bolus tube feeding in preterm infants: pilot randomized clinical trial. Am J Perinatol. 2020;38(14):1526–32.

    PubMed  Google Scholar 

  48. Xu LC, Huang XJ, Lin BX, Zheng JY, Zhu HH. Clinical nurses’ nasogastric feeding practices in adults: a multicenter cross-sectional survey in China. J Int Med Res. 2020;48(4):300060520920051.

    Article  PubMed  Google Scholar 

  49. Chen CX, Wei ZD, Liu YJ, Cheng SZ, Guan XD. Bedside rapid placement of nasointestinal feeding tube via ultrasound-guided stylet positioning in critical COVID-19 patients. Crit Care. 2020;24(1):361.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Quilliot D, Michot N, Germain L, Krier J, Lopez A, Bresler L, Ayav A, Malgras A, Nguyen-Thi PL. Feasibility, acceptability of enteral tube feeding and self-insertion of a nasogastric tube in the nutritional management of digestive cancers, impact on quality of life. Clin Nutr. 2020;39(6):1785–92.

    Article  PubMed  Google Scholar 

  51. Bager P, Olesen L, Baltzer RL, Borre M, Aagaard NK. Equal efficacy of gastric and jejunal tube feeding in liver cirrhosis and/or alcoholic hepatitis: a randomised controlled study. Br J Nurs. 2020;29(20):1148–54.

    Article  PubMed  Google Scholar 

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Acknowledgements

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Author notes

  1. Chuanjin Liu, Junxun Jiang and Zunjia Wen contributed equally to this work.

Authors and Affiliations

  1. Department of Critical Care Medicine, Division II, Pingxiang People’s Hospital, Pingxiang, China

    Chuanjin Liu

  2. Department of Neurosurgery, Pingxiang People’s Hospital, Pingxiang, Jiangxi Province, 337000, China

    Junxun Jiang & Tao You

  3. Department of spinal surgery, Pingxiang People’s Hospital, Pingxiang, China

    Junxun Jiang

  4. School of Public Health, Fudan University, Shanghai, China

    Zunjia Wen

Authors
  1. Chuanjin Liu
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  2. Junxun Jiang
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  3. Zunjia Wen
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  4. Tao You
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Contributions

CL, JJ, and ZW designed research; CL, JJ, ZW, and Y T conducted research; CL, JJ, ZW, and Y T analyzed data; CL and ZW wrote the first draft of the manuscript; CL and YT had primary responsibility for final content. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Chuanjin Liu or Tao You.

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Liu, C., Jiang, J., Wen, Z. et al. Naso-intestinal versus gastric tube for enteral nutrition in patients undergoing mechanical ventilation: a systematic review and meta-analysis. Syst Rev 14, 13 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13643-024-02743-6

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13643-024-02743-6

Keywords

Systematic Reviews

ISSN: 2046-4053