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Mo, Lee, Jeon, Kim, Kim, Jang, and Lee: Efficacy of Feeding Pump for Patients on Enteral Tube Feeding: A Systematic Literature Review and Analysis
Original Article

Korean J Gastroenterol 2014;63(2):99-106.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.63.2.99

Efficacy of Feeding Pump for Patients on Enteral Tube Feeding: A Systematic Literature Review and Analysis

Jin A Mo1, 2, Seon Heui Lee1, Mi Hye Jeon1, Kyung Sik Kim3, Hwa Soon Kim2, Jae Young Jang4, Myung Duk Lee5

1National Evidence-based Health Care Collaborating Agency, Seoul, Korea

2Department of Nursing, Inha University College of Medicine, Incheon, Korea

3Department of Surgery, Yonsei University College of Medicine, Seoul, Korea

4Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea

5Department of Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea

Correspondence to: Myung Duk Lee, Department of Pediatric Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea. Tel: +82-2-2258- 6092, Fax: +82-2-596-2944, E-mail: myungdlee@gmail.com

Received 14 November 20132 January 2014       Accepted 15 January 2014

Copyright © 2014 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

This study was conducted to establish a guideline on the utilizing of feeding pump in patients requiring enteral tube feeding.

Methods

As a first step, textbooks on nutrition and guidelines from regional clinical nutrition societies were analyzed. Afterwards, data on the efficacy, safety, and practicality of feeding pump application were collected and evaluated by systematically reviewing the related literature. As data sources, 8 domestic databases including KoreaMed and global databases such as Ovid-MEDLINE, Ovid-EMBASE, and Cochrane Library were utilized. A total of 2,016 related articles was selected by applying the keyword “(enteral feeding.mp AND pump.mp)”.

Results

Textbooks and guidelines were not able to draw conclusions on the effects of the feeding pump because the injection speed, tube size, and etcetera were different for enteral feeding. Feeding pump assisted enteral tube feeding was an efficient, safe, and practical procedure for reducing maladjustment-related complications of enteral tube feeding, which are obvious obstacles for maintaining nutritional balances in patients requiring tube feeding.

Conclusions

Feeding pump application can be considered an efficient and safe measure that is acceptable in patients on small intestinal tube feeding, critically-ill patients on gastrointestinal tube feeding, premature babies, and critically-ill or severely malnourished children (recommendation grade D).

Keywords: Enteral nutrition, Feeding methods, Review

References

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2. Kim H, Choi SH, Ham YJ. Nutritional status and indicators of intensive care unit patients on enteral feeding. J Korean Acad Fundam Nurs. 2009; 16:21–29.
3. Kim EM. Feeding pump. J Korean Soc Parenter Enter Nutr. 2010; 3:23–26.
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Fig. 1.
Flow diagram of the article selection process.
kjg-63-99f1.tif
Table 1.
Ovid-MEDLINE and EMBASE Search Strategy
PICO No Search term Searched literature (n)
MEDLINE EMBASE
Intervention 1 (continuous∗ or enter∗).mp 569,028 808,196
  2 (nutrition∗ or feed∗).mp 479,194 637,210
  3 1 AND 2 40,241 57,349
Comparators 4 (intermittent or bolus).mp 95,752 129,443
  5 3 AND 4 978 1,398
Human 6 animal/ 4,996,634 1,787,973
  7 human/ 12,410,338 13,549,870
  8 6 not (6 and 7) 3,659,357 1,339,269
  9 5 not 8 720 1,296
Total     720 1,296

PICO, Patients-Intervention-Comparators-Outcomes.

Table 2.
Levels of Evidence
1++ + High quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias
1+ Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias
1− Meta-analyses, systematic reviews, or RCTs with a high risk of bias
2++ + High quality systematic reviews of case control or cohort or studies
  High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal
2+ Well-conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal
2− Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal
3 Non-analytic studies, e.g., case reports, case series
4 Expert opinion

RCT, randomized controlled trial.

Table 3.
Grades of Recommendations27
A At least one meta-analysis, systematic review, or RCT rated as 1++, and directly applicable to the target population; or a body of evidence consisting principally of studies rated as 1+, directly applicable to the target population, and demonstrating overall consistency of results
B A body of evidence including studies rated as 2++, directly applicable to the target population, and demonstrating overall consistency of results; or extrapolated evidence from studies rated as 1++ or 1+
C A body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results; or extrapolated evidence from studies rated as 2++
D Evidence level 3 or 4; or extrapolated evidence from studies rated as 2+

RCT, randomized controlled trial.

Table 4.
Documents Selected for Evaluation of Feeding Pump
First author Research type Publication year Research location Subject (n, duration) Intervention Comparator Level of evidence
Horn15 RCT 2003 Australia Ill child (45, 6 mo) Continuous+ pump Intermittent 1++
Dollberg16 RCT 2000 Israel 501-1,250 g premature infants (28, 26.8±0.4 wk) Continuous+ pump Bolus feeding 1++
Akintorin17 RCT 1997 USA ≤1,250 g premature infants (80, 28.8±1.9 wk) Continuous+ pump Intermittent 1++
Shimoni18 RCT 2007 Israel ≥80 yr patients (148, 81.0±10 yr) Continuous+ pump Intermittent 1+
Chen19 RCT 2006 Taiwan Adult patients in ICU (107, no mention) Continuous+ pump Intermittent 1+
Horn20 RCT 2004 Australia Ill paediatric patients (45, 6 mo) Continuous+ pump Intermittent 1+
Lee21 RCT 2003 China ≥80 yr patients in neurology ICU (74, 81.3±1.5 yr) Continuous+ pump Intermittent 1+
Tamowicz22 2 RCT 2007 Poland 18-75 yr patients with respirator (40, no mention) Continuous+ pump Intermittent 1−
Ciocon23 RCT 1992 USA ≥60 yr patients with swallowing disorders (60, 72±9 yr) Continuous+ pump Intermittent 2−
Rojahn24 NRCT 2001 Norway <1,250 g premature infants (49, 27 wk) Continuous+ pump Bolus feeding 2−
Toce25 NRCT 1987 USA ≤1,500 g premature infants (53, 30.7±0.3 wk) Continuous+ pump Bolus feeding 2−

RCT, randomized controlled trial; NRCT, non-randomized controlled trial; ICU, intensive care unit.

Table 5.
Studies on Safety of the Feeding Pump for Enteral Tube Feeding
Category First author (year) Subject Intervention Comparator p-value L Level of evidence
NEC Dollberg (2000)16 Premature infants 2/12 (16.6) 3/16 (18.7) NS 1++
  Akintorin (1997)17 Premature infants 4/39 (10.2) 1/41 (2.4) - 1++
  Rojahn (2001)24 Premature infants 0/25 (0) 2/24 (8.3) 0.45 2−
  Toce (1987)25 Premature infants 2/30 (7) 0/23 (0) NS 2−
Pneumonia Shimoni (2007)18 ≥80 yr patients 0 0 - 1+
  Chen (2006)19 Adult patients in ICU 26/51 (50.9) 8/56 (14.3) 0.000 1+
  Tamowicz (2007)22 18-75 yr patients with respirator 7/20 (35) 4/20 (20) > >0.05 1−
Diarrhea Horn (2003)15 Ill child 6/22 (27) 4/23 (18) 0.30 1++
  Shimoni (2007)18 ≥80 yr patients 4/70 (10.8) 11/78 (26.8) < <0.001 1+
  Lee (2003)21 ≥80 yr patients in neurology ICU 28/37 (75.7) 20/37 (54.1) 0.833 1+
  Ciocon (1992)23 ≥60 yr patients with swallowing disorders 20/no mention 29/no mention 0.008 1−

Values are presented as n/total n (%).

NEC, necrotizing enterocolitis; ICU, intensive care unit; NS, not significant.

Table 6.
Studies on Effectiveness of the Feeding Pump for Enteral Tube Feeding
Category Sub category First author (year) Subject Intervention Comparator p-value Level of evidence Amount
Feeding fitness Residual volume Chen (2006)19 Adult patients in ICU 42/51 (82.3%) 52/56 (92.8%) 0.097 1+ ≥60 mL
    Horn (2004)20 Premature infants 6/22 (27%) 6/23 (26%) - 1+ ≥5 mL/kg
    Lee (2003)21 ≥80 yr patients in Neurology ICU 2/37 (5.4%) 4/52 (10.8%) 0.674 1+ ≥100 mL
  Time to attain full Dollberg (2000)16 Premature infants 9.0 days 12.0 days 0.03 1++  
  enteral feeds Akintorin (1997)17 Premature infants 19.7 days 18.0 days NS 1++ 700-1,000 g
        21.0 days 13.0 days -   1,001-1,250 g
  Volume of formula Horn (2003)15 Ill child 66.2 mL/kg/d 72.8 mL/kg/d 0.39 1++  
    Horn (2004)20 Premature infants 66.2 mL/kg/d 72.8 mL/kg/d 0.39 1+  
    Chen (2006)19 Adult patients in ICU 783±29 kcal/d 795±25 kcal/d 0.1 1+  
    Ciocon (1992)23 ≥60 yr patients with swallowing disorders 21/51 (41.2%) 4/56 (7.1%) −0.00 1− ≥1,000 mL
    Toce (1987)25 Premature infants 93.6 kcal/d 104.0 kcal/d NS 2−  
Weight change Time to regain Dollberg (2000)16 Premature infants 12.0 days 12.0 days 0.81 1++  
  birth weight Akintorin (1997)17 Premature infants 12.8 days 12.9 days NS 1++ 700-1,000 g
        12.5 days 12.0 days NS   1,001-1,250 g
    Rojahn (2001)24 Premature infants 12.0 days 12.0 days 0.81 2−  
  Reach discharge weight Akintorin (1997)17 Premature infants 68 days 49 days NS 1++ 700-1,000 g
        68 days 48 days NS   1,001-1,250 g
  Weight gain Toce (1987)25 Premature infants 13.4 g/kg/d 12.2 g/kg/d NS 2−  

ICU, intensive care unit; NS, not significant.

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