Effect of intragastric versus small intestinal delivery of enteral nutrition on the incidence of pneumonia in critically ill patients: a complementary meta-analysis

As intensive care specialists with a long-time interest in the relative pros and cons of intragastric and small intestinal delivery of enteral nutrition in critically ill patients, we greatly enjoyed reading the excellent metaanalysis performed by Deane and colleagues based on randomized clinical trials (RCTs) [1]. The analysis demonstrated small bowel feeding was associated with a reduced risk of pneumonia (relative risk (RR) 0.75; 95% CI 0.60 to 0.93; P = 0.01). The authors concluded that use of small intestinal feeding may reduce the incidence of ICU-acquired pneumonia. Although this result has significant clinical implications, one important issue should be addressed. Based on the same articles used by Deane and colleagues [1], we performed a complementary meta-analysis to reappraise the effect of intragastric versus small intestinal delivery of enteral nutrition on the incidence of