Critical Analysis of the Factors Associated with Enteral Feeding in Preventing VAP: A Systematic Review

Tuesday, 13 July 2010: 3:45 PM

Yu-chih Chen, PhD
Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan

Learning Objective 1: to describe the steps of implementation evidence based nursing process in clinical setting.

Learning Objective 2: to explore the issues of nursing practice and to discuss the evidence related to these issues

Purpose: The purpose of this systematic review was to synthesize the factors associated with enteral feeding in order to prevent VAP and to describe the characteristics of these factors.

Methods: A comprehensive search was undertaken involving all major databases from their inception to September 2008 using medical subject heading terms associated with enteral feeding in relation to VAP. The overall reference list of identified studies was audited, and eligible studies included randomized controlled trials, controlled before–and-after (pre-post) studies and meta-analyses. To generate the characteristics of the factors associated with VAP, the reported components of these trials were pinpointed and categorized.

Results: A total of 14 papers were found that had investigated the factors linking enteral feeding and VAP. For these, 11 were randomized controlled trials, one was a meta-analysis and 2 were case-controlled analyses. Twelve of these 14 studies were conducted at a single institute and 2 were conducted at multiple institutes. The sample sizes varied from 10 to 2,528 subjects. Three major issues were identified based on the purpose of study interventions, and these were the effects of feeding method (continuous vs. intermittent), feeding site on aspiration (gastric vs. small bowel) and the timing of enteral feeding (early vs. late).

Conclusion: The evidence suggests that a correct choice of enteral feeding method can effectively reduce complications due to aspiration. Furthermore, intermittent enteral feeding and with a small residual volume feed can reduce gastroesophageal reflux and increase total intake volume and early feeding can reduce ICU mortality. Nonetheless, the effects of these choices on preventing VAP still need further evaluation. A set of clinical guidelines based on these evidence-based findings with respect to enteral feeding is required, particularly one that covers all aspects of the enteral feeding process.