Early enteral nutrition (within 48 hours) versus delayed enteral nutrition (after 48 hours) with or without supplemental parenteral nutrition in critically ill adults

Padilla, Paulina Fuentes; Martínez, Gabriel García; Vernooij, Robin W.M.; Urrútia, Gerard; Figuls, Marta Roqué i; Cosp, Xavier Bonfill

doi:10.1002/14651858.cd012340.pub2

Cited by 49 publications

(57 citation statements)

References 110 publications

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“…Fuentes Padilla et al [ 26 ] reported that it was uncertain whether early enteral nutrition, compared with delayed enteral nutrition, affects the risk of mortality within 30 days, feed intolerance or gastrointestinal complications, or pneumonia due to very low-quality evidence. Tian et al [ 27 ] reported that early enteral nutrition reduced mortality and pneumonia compared with delayed enteral intake, but there were no clear clinical advantages of early enteral nutrition over parenteral nutrition.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Initiation Time of Enteral Nutrition for Critically Ill Patients: At Admission vs. 24 to 48 Hours after Admission

Xie

Zhong

et al. 2021

Emergency Medicine International

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Objective. To investigate the better time of initiation of enteral nutrition for critically ill patients, such as at admission or 24 to 48 hours after admission. Methods. This was a prospective, randomized, parallel-controlled, single-blind, interventional clinical trial. A total of 100 patients admitted to the intensive care unit (ICU) of our hospital between January 2017 and December 2018 were recruited in this study. These patients had been divided into the control group or intervention group by a computer-generated random number table, and each group had 50 patients. For the control group, a gastric tube was inserted to start enteral nutrition at 24 to 48 hours after admission. For the intervention group, a nasojejunal tube was placed to start enteral nutrition at admission. The main endpoints included serum albumin and prealbumin at admission and on days 3, 7, and 14 after admission, length of ICU stay, ventilator time, and complications such as diarrhea, gastric retention, esophageal reflux, and pulmonary infection. Results. The results showed that serum albumin and prealbumin were significantly higher in the intervention group than in the control group ( P < 0.05). The length of ICU stay ( P < 0.05) and ventilator time ( P < 0.05) were both significantly shorter in the intervention group than in the control group. The incidences of gastric retention, esophageal reflux, and pulmonary infection were significantly lower in the intervention group than those in the control group ( P < 0.05). Conclusion. In the absence of contraindications, enteral nutrition can be initiated immediately after admission to the ICU (within 6 hours), and feeding nasojejunal tube is recommended. It can improve the nutritional status and prognosis of critical patients, improve the feeding effect, shorten the length of stay in the ICU and the use of the ventilator, and reduce the incidence of complications.

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Section: Discussionmentioning

confidence: 99%

Comparison of the Initiation Time of Enteral Nutrition for Critically Ill Patients: At Admission vs. 24 to 48 Hours after Admission

Xie

Zhong

et al. 2021

Emergency Medicine International

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“…Additionally, some of the older trials have important methodological limitations questioning their internal validity including selection bias, frequent postrandomization exclusions and lack of adherence to the intention-to-treat principle. A recent Cochrane meta-analysis assessed current evidence to be of very low quality, leading to uncertainty as to whether early EN, compared with delayed EN, affects the risk of mortality, feed intolerance or gastrointestinal complications, or pneumonia [ 14 ].…”

Section: Question 1: When To Start?mentioning

confidence: 99%

“…Whether lower amounts of EN or no EN at all would be the best option in patients with severe shock is not known. Still, aggregated data from 11 randomized controlled trials (RCTs, n = 597) show that early EN might decrease infectious complications [ 14 ] presumably via the protection of gastrointestinal wall integrity [ 23 ]. Nevertheless, in NUTRIREA-2 ( N = 2410) and CALORIES ( N = 2400), early EN as compared to PN for no more than 3–5 days did not decrease the infection rate [ 22 , 24 ].…”

Section: Question 2: What About En In Patients Receiving Vasopressor Agents?mentioning

confidence: 99%

A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice

Preiser

Arabi

Berger³

et al. 2021

Crit Care

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The preferential use of the oral/enteral route in critically ill patients over gut rest is uniformly recommended and applied. This article provides practical guidance on enteral nutrition in compliance with recent American and European guidelines. Low-dose enteral nutrition can be safely started within 48 h after admission, even during treatment with small or moderate doses of vasopressor agents. A percutaneous access should be used when enteral nutrition is anticipated for ≥ 4 weeks. Energy delivery should not be calculated to match energy expenditure before day 4–7, and the use of energy-dense formulas can be restricted to cases of inability to tolerate full-volume isocaloric enteral nutrition or to patients who require fluid restriction. Low-dose protein (max 0.8 g/kg/day) can be provided during the early phase of critical illness, while a protein target of > 1.2 g/kg/day could be considered during the rehabilitation phase. The occurrence of refeeding syndrome should be assessed by daily measurement of plasma phosphate, and a phosphate drop of 30% should be managed by reduction of enteral feeding rate and high-dose thiamine. Vomiting and increased gastric residual volume may indicate gastric intolerance, while sudden abdominal pain, distension, gastrointestinal paralysis, or rising abdominal pressure may indicate lower gastrointestinal intolerance.

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“…The potential benefit for early enteral nutrition in trauma patients is still debatable. Included studies are often of low-quality, heterogenous and included a small study population, and still leaves questions unanswered, such as composition of the enteral nutrition used, nutritional goal, use of supplemental parenteral nutrition and adding supplements to the formula [56]. Thus, our current understanding about the role of malnutrition in trauma patients is built upon a thin evidence-base and most of current practice is extrapolated from studies in non-surgical and non-trauma patients.…”

Section: Discussionmentioning

confidence: 99%

Malnutrition and its effects in severely injured trauma patients

Dijkink

Meier

Krijnen

et al. 2020

Eur J Trauma Emerg Surg

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Purpose In hospitalized patients, malnutrition is associated with adverse outcomes. However, the consequences of malnutrition in trauma patients are still poorly understood. This study aims to review the current knowledge about the pathophysiology, prevalence, and effects of malnutrition in severely injured patients. Methods A systematic literature review in PubMed and Embase was conducted according to PRISMA-guidelines. Results Nine review articles discussed the hypermetabolic state in severely injured patients in relation to malnutrition. In these patients, malnutrition negatively influenced the metabolic response, and vice versa, thereby rendering them susceptible to adverse outcomes and further deterioration of nutritional status. Thirteen cohort studies reported on prevalences of malnutrition in severely injured patients; ten reported clinical outcomes. In severely injured patients, the prevalence of malnutrition ranged from 7 to 76%, depending upon setting, population, and nutritional assessment tool used. In the geriatric trauma population, 7-62.5% were malnourished at admission and 35.6-60% were at risk for malnutrition. Malnutrition was an independent risk factor for complications, mortality, prolonged hospital length of stay, and declined quality of life. Conclusions Despite widespread belief about the importance of nutrition in severely injured patients, the quantity and quality of available evidence is surprisingly sparse, frequently of low-quality, and outdated. Based on the malnutrition-associated adverse outcomes, the nutritional status of trauma patients should be routinely and carefully monitored. Trials are required to better define the optimal nutritional treatment of trauma patients, but a standardized data dictionary and reasonable outcome measures are required for meaningful interpretation and application of results.

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Early enteral nutrition (within 48 hours) versus delayed enteral nutrition (after 48 hours) with or without supplemental parenteral nutrition in critically ill adults

Cited by 49 publications

References 110 publications

Comparison of the Initiation Time of Enteral Nutrition for Critically Ill Patients: At Admission vs. 24 to 48 Hours after Admission

Comparison of the Initiation Time of Enteral Nutrition for Critically Ill Patients: At Admission vs. 24 to 48 Hours after Admission

A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice

Malnutrition and its effects in severely injured trauma patients

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