by Tian, Feng;
Heighes, Philippa T.; Allingstrup, Matilde J.; Doig, Gordon S.
Objectives: To identify,
appraise, and synthesize the most current evidence to determine whether early
enteral nutrition alters patient outcomes from critical illness. Data Sources:
Medline and Embase were searched. The close out date was November 20, 2017.
Study Selection: Early enteral nutrition was defined as a standard formula
commenced within 24 hours of ICU admission. Comparators included any form of
nutrition support “except” early enteral nutrition. Only randomized controlled
trials conducted in adult patients requiring treatment in an ICU were eligible
for inclusion. Data Extraction: The primary outcome was mortality. Secondary
outcomes included pneumonia, duration of mechanical ventilation, and ICU and
hospital stay. Data Synthesis: Six-hundred ninety-nine full-text articles were
retrieved and screened. Sixteen randomized controlled trials enrolling 3,225
critically ill participants were included. Compared with all other types of
nutrition support, commencing enteral nutrition within 24 hours of ICU
admission did not result in a reduction in mortality (odds ratio, 1.01; 95% CI,
0.86–1.18; p = 0.91; I2 = 32%). However, there was a differential treatment
effect between a priori identified subgroups (p = 0.032): early enteral
nutrition reduced mortality compared with delayed enteral intake (odds ratio,
0.45; 95% CI, 0.21–0.95; p = 0.038; I2 = 0%), whereas a mortality difference
was not detected between early enteral nutrition and parenteral nutrition (odds
ratio, 1.04; 95% CI, 0.89–1.22; p = 0.58; I2 = 30%). Overall, patients who were
randomized to receive early enteral nutrition were less likely to develop
pneumonia (odds ratio, 0.75; 95% CI, 0.60–0.94; p = 0.012; I2 = 48%).
Conclusions: Overall, there was no difference between early enteral nutrition and
all other forms of nutrition support. A priori planned subgroup analysis
revealed early enteral nutrition reduced mortality and pneumonia compared with
delayed enteral intake; however, there were no clear clinical advantages of
early enteral nutrition over parenteral nutrition.
No comments:
Post a Comment