1. No category

表2B-1. feedint tubeの幽門前後構造化抄録
Title
Author
reference
Nutritional
outcome and
pneumonia in
critical care
patients
randomized to
gastric versus
jejunal tube
feedings. The
Critical Care Montecalvo MA, Crit Care Med
Research
Steger KA, Farber 1992, 20:1377Team.
HW, et al.
1387.
Duodenal
versus gastric
feeding in
ventilated
blunt trauma
patients: a
randomized
controlled
Kortbeek JB,
trial.
Haigh PI, Doig C.
患者背景
比較群
MICU/SICU (n =SB(n=19)
38)
ICU死亡率
肺炎発症率
ICU在室日数 在院日数
平均±SD
人工呼吸期間mean
栄養の結果
± SD
平均±SD
エネルギー充足率
5/19 (26%)
4/19 (21%)
11.7± 8.2
人工呼吸患
者。
APACHE2=23(
mean)
N=38、 2 ICUs Gastric(n=19) 5/19 (26%)
6/19 (32%)
12.3 ± 10.8
11.4 ± 10.8 46.9% ± 25.9%
中央値(範囲) 中央値(範囲) 中央値(範囲) 目標到達時間
Trauma
1999, 46:992996, discussion
996-998.
外傷 (n = 80) SB(n=37)
4/37 (11%)
外傷
Injury Severity
Score16以上
人工呼吸が2
日を越える
N=80、 2
ICUsAPACHE
2=18(mean)
Gastric(n=43) 3/43 (7%)
Prospective,
randomized,
controlled trial
to determine
the effect of
early
enhanced
enteral
nutrition on
clinical
outcome in
mechanically
ventilated
patients
Taylor SJ, Fettes Crit Care Med
suffering head SB, Jewkes C,et 1999;27:2525injury.
al.
31
SB(n=41)
5/41 (12%)at
6 mo
10.2 ± 7.1
合併症
GI bleeding
7/19 (37%)
Diarrhea
12/19 (63%)
Vomiting
3/19 (16%)
GI bleeding
6/19 (32%)
Diarrhea
9/19 (47%)
Vomiting
3/19 (16%)
61.0% ± 17.0%
10 (3-24)
30 (6-47)
9 d (2-13 d)
34.0 ± 7.1 h
18/43 (42%)
7 (3-32)
25 (9-88)
5 d (3-15 d)
43.8 ± 22.6 h
エネルギー充足率 窒素投与充足率
59.20%
68.70%
36.80%
37.90%
頭部外傷で10
歳を越える
N=82
Gastric(n=41) 6/41 (15%)at 6 mo
26/41 (63%)
NR
For Puclic Comment　表2B-1. 1ページ
C.Random: not
sure
ITT: no
Blinding: no
C.Random:
yes
ITT: yes
Blinding: no
10/37 (27%)
18/41 (44%)
統計の条件
37 % major
complications
61 % had
better
neurological
outcome at 3
months
61 % major
complications
39 % had
better
neurological
outcome at
3months
C.Random: not
sure
ITT: yes
Blinding: no
不採用の理由
平均±SD
The
incidence of
ventilatorassociated
pneumonia
and success
in nutrient
delivery with
gastric versus
small
intestinal
feeding: a
Crit Care Med
randomized
Kearns PJ, Chin 2000, 28:1742clinical trial.
D, Mueller L, et al. 1746.
Early versus
delayed
feeding with
an immuneenhancing
diet in
patients
with severe Minard G1,
head
Kudsk KA,
injuries.
Melton S, etal.
MICU (n = 44) SB(n=21)
5/21 (24%)
MICU
人工呼吸を必
要としている
症例
APACHE
2=21(mean)
N=44
Gastric(n=23) 6/23 (26%)
4/21 (19%)
17 ± 2
39 ± 10
69% ± 7%
18 ±1
3/23 (13%)
16 ± 2
43 ± 11
平均±SD
平均±SD
47% ± 7%
12 ± 2
5日以上目標の
50％以上栄養投 目標到達時間
与出来た症例
(h)
0.7 ± 0.1
0.4 ± 0.1
平均エネル
ギー投与量
(kcal/day)
下痢
3日
C.Random: not
sure
ITT: yes
Blinding: no
下痢
2日
JPEN J
Parenter
Enteral Nutr.
2000 ;24:1459.
SB(n=12)
外傷
GCS 3-10
N=27
Gastric
feeding with
erythromycin
is equivalent
to
transpyloric
feeding in the Boivin MA, Levy
critically ill.
H:
平均±SD
平均エネルギー
投与量
平均蛋白投与
エネルギー充足率 (kcal/day)
量g/kg/day)
1/12 (8%)
Gastric(n=15)4/15 (27%)
Crit Care Med MICU/SICU/n
2001, 29:1916- euro ICU (n =
1919.
80)
SB(n=40)
18/39 (46%)
重症患者
APACHE2=16.
5(mean)
N=80
Gastric(n=40) 18/39 (46%)
6/12 (50%)
18.5 ± 8.8 30 ± 14.7
7/15 (47%)
11.3 ± 6.1 21.3 ± 14.7 10.4 ± 6.1 d7/15 (47%)
目標到達時間
NR
15.1 ± 7.5 d10/12 (83%)
33 h
32 h
For Puclic Comment　表2B-1. 2ページ
33 ± 15
1509 ± 45
C.Random: not sure
84 ± 41
1174 ± 425
ITT: no Bliinding:Yes
C.Random: not
sure
ITT: no
Blinding: no
エネルギー充足率
Equal
aspiration
rates in
gastrically and
transpyloricall Esparza J, Boivin
y fed critically MA, Hartshorne
ill patients.
MF,et al.
Intensive Care
Med
2001, 27:660664.
Gastric versus
duodenal
feeding in
patients with
J Neurosci
neurological
Nurs 2001,
disease: a
Day L, Stotts NA, 33:148-149,
pilot study.
Frankfurt A, et al. 155-159.
MICU (n = 54) SB(n=27)
10/27 (37%)
MICU
MV = 98%
APACHE
=16(mean)
N=54
Gastric(n=27) 11/27 (41%)
SB(n=13)
NR
Neurological
ICU　72時間
以上栄養療法
が必要と判断
された症例
APACHE
=48(mean)
N=24
Gastric(n=11) NR
Effect of
postpyloric
feeding on
gastroesophag
eal
regurgitation
and pulmonary
microaspiratio
n: results of a
randomized
controlled
trial.
Heyland DK,
Drover JW,
MacDonald S, et
al.
Crit Care Med
2001, 29:14951501
Adult ICU
patients
expected to
remain
mechanically
ventilated for
> 72 hours
Mean age: 59
years
Male: 58%
Mean
APACHE II
score: 22
ND (n = 12)
NG (n = 21)
NR
C.Random: not
sure
ITT: yes
Blinding: no
66.00%
64.00%
栄養チューブ入れ替え
0/14 (0%)
2/11 (18%)
NR
NR
NR
下痢
7/14 (50)
16 per group
9 per group
誤嚥
嘔吐
4/12(33%)
11/21(52.4%)
11/12(92%)
17/21(83%)
For Puclic Comment　表2B-1. 3ページ
下痢
5/11 (45)
マイクロアスピレーション
食道胃逆流
7.50%
3.90%
39.80%
24.90%
C.Random: not
sure
ITT: yes
Blinding: no
平均±SD
Randomized
comparison of
nasojejunal
and
nasogastric
feeding in
Davies AR,
Crit Care Med
critically ill
Froomes PR,
2002,
patients.
French CJ, et al. 30:586-590.
MICU/SICU (n =SB(n=34)
73)
4/34 (12%)
2/31 (6%)
13.9 ± 1.8
目標投与量到達時間
NR
消化管出血
3/31 (10%)
下痢
4/31 (13%)
23.2 ± 3.9 h
C.Random: not
sure
ITT: no
Blinding no
成人重症症例
MV=90%;
APACHE2=20(
mean
N=73
Gastric(n=39) 5/39 (13%)
Multicenter,
prospective,
randomized,
single-blind
study
comparing the
efficacy and
gastrointestin
al
complications
of early
jejunal feeding
with early
gastric feeding
Crit Care
in critically ill Montejo JC, Grau Med 2002,
patients.
T, Acosta J, et al. 30:796-800
SB(n=50)
19/50 (38%)
APACHE2=18(
mean)
5日を越えて
栄養療法が必
要な症例
N=101
Gastric(n=51) 22/51 (43%)
Gastric
versus smallbowel tube
feeding in
the intensive
care unit: a
prospective
comparison of Neumann DA,
efficacy.
DeLegge MH
1/35 (3%)
16/50 (32%)
20/51 (39%)
10.4 ± 1.2
平均±SD
15 ± 10
18 ± 16
23.0 ± 3.4 h
第7日目での栄養充足率
エネルギー投与量(mean)
(mean)
消化管出血
0/35 (0)
下痢
3/35 (9)
1286 ± 344
下痢
7/50 (14%)
嘔吐
4/50 (8%)
75% ± 30%
1237 ± 342
下痢
7/51 (14%)
嘔吐
2/51 (4%)
栄養投与を行おう
とし始めた時間か
ら投与開始までの
時間
栄養チューブ挿
入開始から目標
投与量までの到
達時間
80% ± 28%
C.Random: not
sure
ITT: yes
Blinding: no
栄養チューブ
挿入完了から
目標投与速度
到達までの時
間
Crit Care
Med 2002,
30:1436-1438
MICU (n = 60) Post pyloric (n =NR
30)
成人重症症例
、 5日を越え
て栄養療法が
必要な症例
Mean
APACHE II
score: NR
NG (n = 30)
NR
27.0 ± 22.6
43.0 ± 24.1 h
17.3 ± 15.7
誤嚥
1/30 (3%)
11.2 ± 11.0
28.8 ± 15.9 h
17.0 ± 11.9
誤嚥
0/30 (0%)
For Puclic Comment　表2B-1. 4ページ
C.Random: not
sure
ITT: yes
Blinding: no
Gastric vs
small-bowel
feeding in
critically
ill children
receiving
mechanical
ventilation: a
randomized
controlled
trial.
Meert KL,
Daphtary KM,
Chest
Metheny NA. et al 2004;126:872
ICU患者にお
ける幽門後栄
養チューブの
使用経験につ
いて―医療リ 野口 佳奈, 河田
スクを減らす 玲奈, 安田 健司
ために
et al
Pediatric,
mixed,
postpyloric
ventilated
(PRISM score 8.2)
脳血管障害症
例30例、
JJPEN 2005 20 51APACHE2:NA ED(n=15)
11.1+-2.1
NG(n=15)
NR
誤嚥
嘔吐
エネルギー充足率
20/30(67%)
19/32(59%)
10/30(33%)
10/32(31%)
47+-22%
30+-23%
NR
pseudo
ramdamization
OPEN label,
1ICU
逆流､嘔吐：な
し、腹部膨
満:4/15(27%)
逆流、嘔
吐:3/15(20%),
腹部膨満：な
し
10.2+-2.7
Canadian,
SCCMでは不
採用
A randomized
study of early
nasogastric
versus
nasojejunal
feeding
insevere
Eatock FC, Chong
acute
P, Menezes N et
pancreatitis. al.
Am J
Gastroenterol
2005, 100:432439
Adult patients
with severe
acute
pancreatitisMe
dian age: 60
yearsMale:
53%Median
APACHE II
score at day1:
11Mechanicall
y ventilated
patients: 15
(31%)
Patients
admitted to
ICU: 15 (31%) NJ (n = 22)
NG (n = 27)
50％未満の症
例しかICUに
は行っていな
い
7/22(31.8)
5/27(18.5)
下痢
Early enteral
nutrition in
severe acute
pancreatitis: a
prospective
randomized
controlled trial
comparing
nasojejunal
and
nasogastric
Kumar A, Singh N,
routes.
Prakash S,et al.
J Clin
Gastroenterol
2006,40:431434.
Adult patients
with severe
acute
pancreatitis
as defined by
Atlanta
criteriaAdmitt
ed to ICU
Mean age: 40
years　Males:
83%Mean
APACHE II
score:
10Respiratory
failure: 19
(63%)
NJ(n=14)
NG(n=16)
4/14(27%)
5/16(31.3%)
1/14(6.7%)
3/15(20%)
4/16(25%)
0
For Puclic Comment　表2B-1. 5ページ
RCT
平均
Duodenal
versus gastric
feeding in
medical
intensive care
unit patients:
a
prospective,
Crit Care Med
randomized,
Hsu CW, Sun SF, 2009, 37:1866clinical study. Lin SL, et al.
1872.
Medical ICU人
工呼吸症例。
3日を越えて
栄養療法が必
要な症例
NJ(n=59)
N=121
A randomised
controlled
comparison of
early postpyloric versus
early gastric
feeding to
meet
nutritional
targets in
ventilated
White H,
intensive care Sosnowski K,
patients.
Tran K,
Medical ICU
人工呼吸を行
う症例
APACHE2=27(
Crit Care 2009, mean),群間で
13:
APACHE２は
R187.
有意差有り
NJ(n=50)
N=108
Gastric versus
transpyloric
feeding in
severe
traumatic
brain injury: a
prospective,
randomized
trial.
NG(n=62)
NG(n=54)
頭部外傷にて
ICUで48時間
以上人工呼吸
Acosta-Escribano
をおこなう症
J, FernandezIntensive Care 例、
Vivas M, Grau
Med 2010,
APACHE2=17(
Carmona T,
36:1532-1539. mean)
NJ(n=50)
N=104
NG(n=54)
26/59 (44%)
24/62 (39%)
11/50 (22%)
5/54 (9%)
6/50 (12%)
9/54(16.7%)
5/59 (9%)
15/62 (24%)
5/50 (10%)
11/54 (20%)
16/50 (32%)
31/54 (57%)
平均
平均
栄養充足率 (mean)エネルギー投与量蛋白投与量
(kcal/day) (grams/day)
28.5 ± 24.9
18.20 ± 11.20 31.7 + 21.1
中央値(範囲)および平均,SD
嘔吐
8/62 (13)
消化管出血
9/62 (15)
目標到達まで
の時間
23.8 ± 18.2 83 ± 6
1426 ±110
58.8 (4.9)
54.5 hrs
中央値(範囲)および平均,SD
エネルギー投与量(中央値、四分位点)
蛋白投与量(中央値、四分位点) 目標までの到達時間
5.3 (2.73-9.89)
7.12 ± 6.00
(51)
3.93 (2.3-8.38)
5.73 ± 5.29
(51)
1463 (1232-1804) 63 (50-78)
5.02 (1.989.99)
9.10 ± 10.55
(55)
平均,SD
平均,SD
3.92 (1.5-8.54)
7.68 ± 9.81
(55)
1588 (913-1832) 69 (45-87)
平均,SD
エネルギー充足率 (mean,SD)
18 ± 7 (54)
38 ± 24 (50) 7.3 ± 4 (50)
41 ± 28 (54) 8.9 ± 4 (54)
92 ± 7
84 ± 15
For Puclic Comment　表2B-1. 6ページ
1658 ± 118
67.9 (4.9)
C.Random:
Yes
ITT: Yes
Blinding: No
(9)
18.20 ± 11.80 36.0 ± 24.2
16 ± 9 (50)
95 ± 5
嘔吐
1/59 (2%)
消化管出血
7/59 (12%)
目標到達まで
の時間
32.4 hrs
4.1 (3.4-5.0)
hrs
C.Random:
Yes
ITT: Yes
Blinding: No
4.3 (4.0-5.0)
GIT
C.Random: No
complications ITT: Yes
7/50 (14)
Blinding:no
GIT
complications
27/54 (47)
中央値(範囲) 中央値(範囲) 中央値(範囲)
および平
および平
および平
エネルギー充足
均,SD
均,SD
均,SD
率 (mean, SD)
A multicenter,
randomized
controlled trial
comparing
early
nasojejunal
with
nasogastric
Davies AR,
nutrition in
Morrison SS,
critical illness. Bailey MJ
Crit Care Med
2012, 40:23422348.
重症患者で人
工呼吸を受
け、鎮静薬を
投与されてい
る、16歳以上
の症例。
APACHE2=20(
mean)
N=181
NJ(n=91)
NG(n=89)
Severity of
illness
influences the
efficacy of
enteral
feeding route
on clinical
outcomes in
J Acad Nutr
patients with Huang HH, Chang Diet 2012,
critical illness. SJ, Hsu CW et al. 112:1138-46
medical ICU,
24時間以上人
工呼吸を必要
とする症例
Mean
APACHE II
score: 21
n=101
ND (n = 50)
NG (n = 51)
Evaluation of
early enteral
feeding
through
nasogastric
and
nasojejunal
tube in severe
acute
pancreatitis: a
noninferiority
randomized
Singh N, Sharma
controlled
B, Sharma M, et
trial.
al.
13/91 (14%)
18/91 (20%)
12/89(13%)
19/89 (21%)
10 (7-15)
12.5 ± 8.6
20 (11-33)
28.8 ± 26.1
8 (6-12)
9.8 ± 6.2
11 (7-16)
12.7 ± 9.8
mean(SD)
24 (15-32)
27.4 ± 21.1
8 (5-14)
9.7 ± 6.3
72 %
エネルギー投与
量
1497 ± 521
71%
1444 ± 485
エネルギー充足率 (mean, SD)
合併症
出血
2/91 (2%)
少量の出血
12/91 (13)
嘔吐
30/91 (33%)
誤嚥
5/91 (5%)下痢
26/91 (29%)
腹部膨満
16/91 (18%)
出血
2/89 (2%)
少量出血
3/89 (3%)
嘔吐
30/89 (30%)
誤嚥
4/89 (5%)
下痢
26/89 (30%)
腹部膨満
18/89 (20%)
C.Random:
Yes
ITT: Yes
Blinding: No
出血
7/50 (15%)
20/48(41.7%)
17/48(35.4%)
5/50(10%)
9/51(17.6%)
17.2(11.4)
50(16.9)
90.4 +/- 20.5%
76.2 +/- 24.9%
Random: Yes
Hsuのデータと
同じものを
使っているた
め、メタアナリ
シスには使用
できないため
Canadianでは
外されている
出血
8/51 (15.7%)
Pancreas 2012,
NJ (n = 39)
41:153-159.
Adult patients with severe acute
7/39(18)
pancreatitisas defined by:Atlanta criteria, APACHE II > 8 or CT severityindex
NA> 7All patients were admitted to ICU.Mean
感染症発生
age: 39 yearsMales:
35.90%
68%Median
RCT
APACHE II score: 8.2
NG (n = 39)
4/39(10.3)
23.10%
Endoscopic placement
有意でない
有意
For Puclic Comment　表2B-1. 7ページ
NTT=8．胃か
ら投与すると
感染症発生が
抑えられる。
（非劣勢試験）
Blinding: No
comparison of
nose jejunal
tube and
nasogastric
tube in
providing early
enteral
nutrition for
patients with
severe
craniocerebral Zeng R-c, Jiang
injury.
F-g, Xie Q:
Can
percutaneous
endoscopic
jejunostomy
prevent
gastroesophag
eal reflux in
patients with
preexisting
Lien HC, Chang
esophagitis
CS, Chen GH.
詳細不明
不採用：詳細
不明。本文も
手に入れられ
ず。
% Time esophageal pH <4
不採用：詳細
不明。本文も
手に入れられ
ず。
Chinese J Clin Nutr
Adult
2010,
patients
18:3. with
NJ (n
severe
= 20) craniocerebralinjuryMean age: 40 yearsMales: 63%Mean APACHE II score: NR
NG (n = 20)
Am J Gastroenterol.
Neuro
2000
CVA
;95:3439-43.
(n = 8)
経皮的挿入です。
12.9 min (4.9-28.2)
24.0 min (19.0-40.6)
For Puclic Comment　表2B-1. 8ページ
Blinding: no
経皮的挿入で
ある。