Permissive or Trophic Enteral Nutrition and Full Enteral Nutrition Had Similar Effects on Clinical Outcomes in Intensive Care: A Systematic Review of Randomized Clinical Trials

Abstract

The aim of this study was to systematically review the effect of permissive underfeeding/trophic feeding on the clinical outcomes of critically ill patients. A systematic review of randomized clinical trials to evaluate the mortality, length of stay, and mechanical ventilation duration in patients randomized to either hypocaloric or full-energy enteral nutrition was performed. Data sources included PubMed and Scopus and the reference lists of the articles retrieved. Two independent reviewers participated in all phases of this systematic review as proposed by the Cochrane Handbook, and the review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 7 randomized clinical trials that included a total of 1,717 patients were reviewed. Intensive care unit length of stay and mechanical ventilation duration were not statistically different between the intervention and control groups in all randomized clinical trials, and mortality rate was also not different between the groups. In conclusion, hypocaloric enteral nutrition had no significantly different effects on morbidity and mortality in critically ill patients when compared with full-energy nutrition. It is still necessary to determine the safety of this intervention in this group of patients, the optimal amount of energy provided, and the duration of this therapy.

Predictive value of transabdominal intestinal sonography in critically ill patients: a prospective observational study

“…Although the early administration of normocaloric enteral nutrition has been associated with favorable clinical outcomes [38, 39], the presence of feeding intolerance increases the risk for aspiration pneumonia or enterogenic infection [40–43]. A recent systematic review showed that hypocaloric enteral nutrition, compared with full-energy nutrition, did not significantly affect morbidity or mortality [44]. While if there is no feeding intolerance, continuous trophic feeding can result in the delayed recovery of total enteral nutrition.…”

Gastrointestinal Manifestations of COVID‐19: Impact on Nutrition Practices

“…A meta-analysis has shown that low-dose EN is favored over the full dose in the first week of critical illness. 23 During critical illness, the protein goal is set at 1.2-2.0 g/kg ABW/d, as this target has been shown to improve survival of frail patients. 15,16 Continuous feeding is recommended over bolus feeding to reduce the incidence of diarrhea.…”

Safety, Tolerability, and Outcomes of Enteral Nutrition in Extracorporeal Membrane Oxygenation

“…Available data suggest energy expenditure during ECMO may have wide variance, further emphasizing the potential benefit of a reliable method to measure it. Until there is more clarity, it is reasonable to start EN at trophic or hypocaloric doses and advance over the first week of critical illness to energy targets calculated using existing predictive equations or simplistic weight‐based equations 31 . Clinical judgment should be used to interpret equations that use body temperature as a variable because of the thermoregulatory effect of an extracorporeal circuit.…”