Critical Illness

CI: Monitoring Delivery of Energy (2006)

• Intervention
  Is there evidence of harm for certain populations of patients when they receive over 70% of their enteral nutrition goal intake?

  • Conclusion

    There is initial evidence in one trial of positive quality and one trial of neutral quality to suggest that achieving greater than 70% of goal intake may have less positive outcomes for medical ICU and surgical patients with obesity, when compared to individuals who received less EN.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Is there evidence of harm for certain populations of patients when they receive over 70% of their enteral nutrition goal intake?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Dickerson RN, Boschert KJ, Kudsk KA, Brown RO. Hypocaloric enteral tube feeding in critically ill obese patients. Nutrition. 2002; 18: 241-246.
      • Krishnan JA, Parce PB, Martinez, Dietz GB, Brower RG. Caloric intake in medical ICU patients: consistency of care with guidelines and relationship to clinical outcomes.  Chest 2003;124:297-305.
  • Search Plan and Results: CI: Monitoring Delivery of Energy 2003
     
  What average amount of enteral nutrition intake actually delivered is associated with improved mortality in critically ill patients?

  • Conclusion

    To date, studies evaluating average amount of EN intake actually delivered have not been adequately powered to detect differences in mortality in critically ill patients.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What average amount of enteral nutrition intake actually delivered is associated with improved mortality in critically ill patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Atkinson S, Sieffert E, Bihari D. A prospective, randomized, double blind, controlled clinical trial of enteral immunonutrition in the critically ill. Critical Care Medicine, Vol 26(7) July 1998: 1164-1172
      • Bower, RH, Cerra FB, Bershadsky B, Licari, JJ, Hoyt DB, Jensen GL, Van Buren CT, Rothkpf MM, Daly JM, Adelsberg BR. Early enteral administration of a formula (Impact Registered Trademark) supplemented with arginine, nucleotides, and fish oil intensive care unit patients: Results of a multicenter, prospective, randomized, clinical trial. Critical Care Medicine, Volue 23(3) March 1995 pp 436-449.
      • Dickerson RN, Boschert KJ, Kudsk KA, Brown RO. Hypocaloric enteral tube feeding in critically ill obese patients. Nutrition. 2002; 18: 241-246.
      • Krishnan JA, Parce PB, Martinez, Dietz GB, Brower RG. Caloric intake in medical ICU patients: consistency of care with guidelines and relationship to clinical outcomes.  Chest 2003;124:297-305.
      • Kudsk KA, Minard G, Croce MA, Brown RO. Lowrey TS, Pritchard FE, Dickerson RN, Fabian TC. A randomized trial of isonitrogenous enteral diets after severe trauma: an immune-enhancing diet reduces septic complications. Ann Surg. 1996: 224 (4); 531-543.
      • Taylor SJ, Fettes SB, Jewkes C, Nelson R. Prospective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury. Critical Care Medicine 1999; 27: 2525-2531.
  • Search Plan and Results: CI: Monitoring Delivery of Energy 2003
     
  What average amount of enteral nutrition intake actually delivered is associated with fewer infectious complications in critically ill patients?

  • Conclusion

    Actual delivery of intake of approximately or 60-70% of EN goal in the first week of ICU admission, is associated with fewer infectious complications in critically ill patients, particularly when initiated within 48 hours of injury or admission.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What average amount of enteral nutrition intake actually delivered is associated with fewer infectious complications in critically ill patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Bower, RH, Cerra FB, Bershadsky B, Licari, JJ, Hoyt DB, Jensen GL, Van Buren CT, Rothkpf MM, Daly JM, Adelsberg BR. Early enteral administration of a formula (Impact Registered Trademark) supplemented with arginine, nucleotides, and fish oil intensive care unit patients: Results of a multicenter, prospective, randomized, clinical trial. Critical Care Medicine, Volue 23(3) March 1995 pp 436-449.
      • Dickerson RN, Boschert KJ, Kudsk KA, Brown RO. Hypocaloric enteral tube feeding in critically ill obese patients. Nutrition. 2002; 18: 241-246.
      • Krishnan JA, Parce PB, Martinez, Dietz GB, Brower RG. Caloric intake in medical ICU patients: consistency of care with guidelines and relationship to clinical outcomes.  Chest 2003;124:297-305.
      • Kudsk KA, Minard G, Croce MA, Brown RO. Lowrey TS, Pritchard FE, Dickerson RN, Fabian TC. A randomized trial of isonitrogenous enteral diets after severe trauma: an immune-enhancing diet reduces septic complications. Ann Surg. 1996: 224 (4); 531-543.
      • Taylor SJ, Fettes SB, Jewkes C, Nelson R. Prospective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury. Critical Care Medicine 1999; 27: 2525-2531.
  • Search Plan and Results: CI: Monitoring Delivery of Energy 2003
     
  What average amount of enteral nutrition intake actually delivered is associated with a shorter length of hospital stay in critically ill patients?

  • Conclusion

    Actual delivery of intake of approximately 60-70% of EN goal in the first week of ICU admission, is associated with a shorter LOS in critically ill patients, particularly when initiated within 48 hours of injury or admission.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What average amount of enteral nutrition intake actually delivered is associated with a shorter length of hospital stay in critically ill patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Atkinson S, Sieffert E, Bihari D. A prospective, randomized, double blind, controlled clinical trial of enteral immunonutrition in the critically ill. Critical Care Medicine, Vol 26(7) July 1998: 1164-1172
      • Bower, RH, Cerra FB, Bershadsky B, Licari, JJ, Hoyt DB, Jensen GL, Van Buren CT, Rothkpf MM, Daly JM, Adelsberg BR. Early enteral administration of a formula (Impact Registered Trademark) supplemented with arginine, nucleotides, and fish oil intensive care unit patients: Results of a multicenter, prospective, randomized, clinical trial. Critical Care Medicine, Volue 23(3) March 1995 pp 436-449.
      • Dickerson RN, Boschert KJ, Kudsk KA, Brown RO. Hypocaloric enteral tube feeding in critically ill obese patients. Nutrition. 2002; 18: 241-246.
      • Kudsk KA, Minard G, Croce MA, Brown RO. Lowrey TS, Pritchard FE, Dickerson RN, Fabian TC. A randomized trial of isonitrogenous enteral diets after severe trauma: an immune-enhancing diet reduces septic complications. Ann Surg. 1996: 224 (4); 531-543.
      • Neumayer LA, Smout RJ, Horn HGS, Horn SD. Early and sufficient feeding reduces length of stay and charges in surgical patients. J Surg Res. 2001 Jan; 95 (1): 73-77.
      • Taylor SJ, Fettes SB, Jewkes C, Nelson R. Prospective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury. Critical Care Medicine 1999; 27: 2525-2531.
  • Search Plan and Results: CI: Monitoring Delivery of Energy 2003
     
  What average amount of enteral nutrition intake actually delivered is associated with less days of mechanical ventilation in critically ill patients?

  • Conclusion

    Actual delivery of intake of approximately 60-70% of EN goal in the first week of ICU admission, is associated with less days of mechanical ventilation in critically ill patients, particularly when initiated within 48 hours of injury or admission.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What average amount of enteral nutrition intake actually delivered is associated with less days of mechanical ventilation in critically ill patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Atkinson S, Sieffert E, Bihari D. A prospective, randomized, double blind, controlled clinical trial of enteral immunonutrition in the critically ill. Critical Care Medicine, Vol 26(7) July 1998: 1164-1172
      • Dickerson RN, Boschert KJ, Kudsk KA, Brown RO. Hypocaloric enteral tube feeding in critically ill obese patients. Nutrition. 2002; 18: 241-246.
      • Krishnan JA, Parce PB, Martinez, Dietz GB, Brower RG. Caloric intake in medical ICU patients: consistency of care with guidelines and relationship to clinical outcomes.  Chest 2003;124:297-305.
      • Kudsk KA, Minard G, Croce MA, Brown RO. Lowrey TS, Pritchard FE, Dickerson RN, Fabian TC. A randomized trial of isonitrogenous enteral diets after severe trauma: an immune-enhancing diet reduces septic complications. Ann Surg. 1996: 224 (4); 531-543.
  • Search Plan and Results: CI: Monitoring Delivery of Energy 2003
     
• Monitoring and Evaluation
  What average amount of enteral nutrition intake actually delivered is associated with reduced cost of medical care in critically ill patients?

  • Conclusion
    To date, studies evaluating average amount of EN intake actually delivered have not been adequately powered to detect differences cost of medical care in critically ill patients.
  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What average amount of enteral nutrition intake actually delivered is associated with reduced cost of medical care in critically ill patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Kudsk KA, Minard G, Croce MA, Brown RO. Lowrey TS, Pritchard FE, Dickerson RN, Fabian TC. A randomized trial of isonitrogenous enteral diets after severe trauma: an immune-enhancing diet reduces septic complications. Ann Surg. 1996: 224 (4); 531-543.
      • Neumayer LA, Smout RJ, Horn HGS, Horn SD. Early and sufficient feeding reduces length of stay and charges in surgical patients. J Surg Res. 2001 Jan; 95 (1): 73-77.
      • Taylor SJ, Fettes SB, Jewkes C, Nelson R. Prospective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury. Critical Care Medicine 1999; 27: 2525-2531.
  • Search Plan and Results: CI: Monitoring Delivery of Energy 2003