Early Enteral Nutrition Reduces Mortality and Improves Other Key Outcomes in Patients With Major Burn Injury: A Meta-Analysis of Randomized Controlled Trials*

Abstract

Objectives: To identify, appraise, and synthesize current evidence to determine whether early enteral nutrition alters patient outcomes from major burn injury. Data Sources: Medline, Embase, and the China National Knowledge Infrastructure were searched. The close out date was May 1, 2018. Study Selection: Early enteral nutrition was defined as a standard formula commenced within 24 hours of injury or admission to ICU or burn unit. Comparators included any form of nutrition support “except” early enteral nutrition. Only randomized controlled trials reporting patient-centered outcomes were eligible for inclusion. Data Extraction: The primary outcome was mortality. Gastrointestinal hemorrhage, sepsis, pneumonia, renal failure, and hospital stay were evaluated as secondary outcomes. Data Synthesis: Nine-hundred fifty-eight full-text articles were retrieved and screened. Seven randomized controlled trials enrolling 527 participants with major burn injury were included. Compared with all other types of nutrition support, early enteral nutrition significantly reduced mortality (odds ratio, 0.36; 95% CI, 0.18–0.72; p = 0.003; I 2 = 0%). Early enteral nutrition also significantly reduced gastrointestinal hemorrhage (odds ratio, 0.21; 95% CI, 0.09–0.51; p = 0.0005; I 2 = 0%), sepsis (odds ratio, 0.23; 95% CI, 0.11–0.48; p < 0.0001; I 2 = 0%), pneumonia (odds ratio, 0.41; 95% CI, 0.21–0.81; p = 0.01; I 2 = 63%), renal failure (odds ratio, 0.27; 95% CI, 0.09–0.82; p = 0.02; I 2 = 32%), and duration of hospital stay (–15.31 d; 95% CI, –20.43 to –10.20; p < 0.00001; I 2 = 0%). Conclusions: The improvements in clinical outcomes demonstrated in this meta-analysis are consistent with the physiologic rationale cited to support clinical recommendations for early enteral nutrition made by major clinical practice guidelines: gut integrity is preserved leading to fewer gastrointestinal hemorrhages, less infectious complications, a reduction in consequent organ failures, and a reduction in the onset of sepsis. The cumulative benefit of these effects improves patient survival and reduces hospital length of stay.

Seven Deadly Sins of Nutrition Therapy in Critically Ill Patients

“…Nutrition therapy should be seen more as a support for other therapies and an additional resource among a set of measures to decrease suffering and improve quality of life in survivors. The impact of nutrition therapy on mortality is uncertain; some studies do not relate it to better outcomes, whereas others do . On the other hand, 1 study found that prolonged nutrition support (≥18 days) was associated with a significant increase in mortality .…”

“…The impact of nutrition therapy on mortality is uncertain; some studies do not relate it to better outcomes, 14,[39][40][41][42][43] whereas others do. 44,45 On the other hand, 1 study found that prolonged nutrition support (ࣙ18 days) was associated with a significant increase in mortality. 46 However, this result must be interpreted with caution since it could simply represent an association between more serious illness and worse outcome.…”

Early Oral Protein-Containing Diets Following Elective Lower Gastrointestinal Tract Surgery in Adults: A Meta-Analysis of Randomized Clinical Trials.

“…Early initiation of a protein-containing diet has been shown to significantly reduce mortality after urgent or emergency surgery for major trauma 7 and major burn injury. 8 Furthermore, pneumonia, sepsis, gastrointestinal hemorrhage and duration of hospital stay are also significantly reduced in these surgical populations. 7,8 We were unable to find any meta-analyses that explicitly focused on the benefits of an early oral protein-containing diet after elective surgery.…”

“…8 Furthermore, pneumonia, sepsis, gastrointestinal hemorrhage and duration of hospital stay are also significantly reduced in these surgical populations. 7,8 We were unable to find any meta-analyses that explicitly focused on the benefits of an early oral protein-containing diet after elective surgery.…”

Establishment of the Screening Scale on the Aspiration Risk of Patients Receiving Enteral Nutrition

“…It was recommended that enteral nutrition should be and implemented as early as possible within 24-48 hours in the patients with critically ill, if the patients' digestive system is normal [1][2][3]. As an important way of nutritional support, enteral nutrition is proved to relieve the severity of diseases, reduce the comorbidities, shorter the hospitalization time and improve the prognosis [4]. However, it was also reported that during the enteral nutrition period, 59.1% patients were complicated with at least one kind of complications [5], among which, the most serious complication is aspiration.…”