Critical Illness

CI: Enteral Nutrition vs. Parenteral Nutrition (2012)

• Intervention
  In adult patients who are critically ill, what is the effect of enteral nutrition (EN) vs. parenteral nutrition (PN) on mortality?

  • Conclusion

    It is unclear whether there is a difference in mortality rate when comparing EN vs. PN in critically ill adult patients.

  • 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: In adult patients who are critically ill, what is the effect of enteral nutrition (EN) vs. parenteral nutrition (PN) on mortality?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Abou-Assi S, Craig K, O'Keefe SJ. Hypocaloric jejunal feeding is better than total pareneteral nutrition in acute pancreatitis: results of a randomized comparative study. Am J Gastroenterol 2002; 97: 2,255-2,262.
      • Adams S, Dellinger EP, Wertz MJ, Oreskovich MR, Simonowitz D, Johansen K. J of Trauma; 1986;26(10);882-891
      • Borzotta, AP, et al. Enteral versus parenteral nutrition after severe closed head injury. J of Trauma. 1994;37(3):459-468.
      • Braunschweig CL, et al. Enteral compared with parenteral nutrition: A meta-analysis. Am J Clin Nutr 2001;74:534-542.
      • Cerra FB, et al. Enteral nutrition does not prevent multiple organ failure syndrome (MOFS) after sepsis. Surgery. 1988;104:272-33.
      • Hadfield RJ, et al. Effects of enteral and parenteral nutrition on gut mucosal permeability in the critically ill. Am J Respir Crit Care Med. 1995;152:1545-1548.
      • Hadley MN, Grahm TW, Harrington T, Schiller WR, McDermott MK, Posillico DB. Nutritional Support and Neurotrauma:  A Critical Review of Early Nutrition in Forty-Five Acute Head Injury Patients.  Neurosurgery 1986; 19: 367-373
      • Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN. 2003; 27: 355-373.
      • Kalfarentzos, F, Kehagias N, Kokkinis MK, Gogos CA. Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial.  BJN; 1997, 84:1665-1669.
      • Kudsk KA, et al. Enteral versus parenteral feeding: Effects on septic morbidity after blunt and penetrating abdominal trauma. Ann Surg. 1992;215(5):503-511.
      • Kutsogiannis J, Alberda C, Gramlich L, Cahill NE, Wang M, Day AG, Dhaliwal R, Heyland DK. Early use of supplemental parenteral nutrition in critically ill patients: Results of an international multicenter observational study. Crit Care Med. 2011 Jul 14. [Epub ahead of print] PMID: 21765355.
      • Moore FA, Feliciano DV, Andrassy RJ, McArdle AH, Booth FV, MOrgenstein-Wagner T B, Kellum, JM, Welling RE and Moore EE. Early Enteral Feeding, Compared with Parenteral, Reduces Postoperative Septic Complications, The results of a Meta-analysis. Ann Surg, 1992, vol 16 (2) p 172-183
      • Simpson F and Doig GS. Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle. Intensive Care Med. 2005; 31: 12-23.
      • Woodcock NP, et al. Enteral versus parenteral nutrition: a pragmatic study. Nutrition 2001;17:1-21.
      • Young B, Ott L, Twyman D, Norton J, Rapp R, Tibbs P, Haack D, Brivins B, Dempsey R. The effect of nutritional support on outcome from severe head injury.  Journal of Neurosurgery 1987; 67:668-76.
  • Search Plan and Results: CI: EN vs. PN 2011
     
  In adult patients who are critically ill, what is the effect of enteral nutrition (EN) vs. parenteral nutrition (PN) on infectious complications?

  • Conclusion

    When compared to PN, EN is associated with reductions in infectious complications in critically ill adult patients.

  • Grade: I
    • 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: In adult patients who are critically ill, what is the effect of enteral nutrition (EN) vs. parenteral nutrition (PN) on infectious complications?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Abou-Assi S, Craig K, O'Keefe SJ. Hypocaloric jejunal feeding is better than total pareneteral nutrition in acute pancreatitis: results of a randomized comparative study. Am J Gastroenterol 2002; 97: 2,255-2,262.
      • Adams S, Dellinger EP, Wertz MJ, Oreskovich MR, Simonowitz D, Johansen K. J of Trauma; 1986;26(10);882-891
      • Borzotta, AP, et al. Enteral versus parenteral nutrition after severe closed head injury. J of Trauma. 1994;37(3):459-468.
      • Braunschweig CL, et al. Enteral compared with parenteral nutrition: A meta-analysis. Am J Clin Nutr 2001;74:534-542.
      • Cerra FB, et al. Enteral nutrition does not prevent multiple organ failure syndrome (MOFS) after sepsis. Surgery. 1988;104:272-33.
      • Hadley MN, Grahm TW, Harrington T, Schiller WR, McDermott MK, Posillico DB. Nutritional Support and Neurotrauma:  A Critical Review of Early Nutrition in Forty-Five Acute Head Injury Patients.  Neurosurgery 1986; 19: 367-373
      • Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN. 2003; 27: 355-373.
      • Kalfarentzos, F, Kehagias N, Kokkinis MK, Gogos CA. Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial.  BJN; 1997, 84:1665-1669.
      • Kudsk KA, et al. Enteral versus parenteral feeding: Effects on septic morbidity after blunt and penetrating abdominal trauma. Ann Surg. 1992;215(5):503-511.
      • Moore FA, et al. TEN versus TPN following major abdominal trauma--reduced septic morbidity. J Trauma. 1989;29:916-923.
      • Moore FA, Feliciano DV, Andrassy RJ, McArdle AH, Booth FV, MOrgenstein-Wagner T B, Kellum, JM, Welling RE and Moore EE. Early Enteral Feeding, Compared with Parenteral, Reduces Postoperative Septic Complications, The results of a Meta-analysis. Ann Surg, 1992, vol 16 (2) p 172-183
      • Simpson F and Doig GS. Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle. Intensive Care Med. 2005; 31: 12-23.
      • Trice S, Melnik G, Page G. Complications and costs of early postoperative parenteral versus enteral nurition in trauma patients. Nutrition in Clinical Practice 1997. 12 (3) 114-119.
      • Woodcock NP, et al. Enteral versus parenteral nutrition: a pragmatic study. Nutrition 2001;17:1-21.
  • Search Plan and Results: CI: EN vs. PN 2011
     
  In adult patients who are critically ill, what is the effect of enteral nutrition (EN) vs. parenteral nutrition (PN) on length of stay (LOS)?

  • Conclusion

    There is limited evidence that early EN vs. PN decreases hospital LOS in critically ill adult patients.

  • 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: In adult patients who are critically ill, what is the effect of enteral nutrition (EN) vs. parenteral nutrition (PN) on length of stay?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Abou-Assi S, Craig K, O'Keefe SJ. Hypocaloric jejunal feeding is better than total pareneteral nutrition in acute pancreatitis: results of a randomized comparative study. Am J Gastroenterol 2002; 97: 2,255-2,262.
      • Adams S, Dellinger EP, Wertz MJ, Oreskovich MR, Simonowitz D, Johansen K. J of Trauma; 1986;26(10);882-891
      • Borzotta, AP, et al. Enteral versus parenteral nutrition after severe closed head injury. J of Trauma. 1994;37(3):459-468.
      • Kudsk KA, et al. Enteral versus parenteral feeding: Effects on septic morbidity after blunt and penetrating abdominal trauma. Ann Surg. 1992;215(5):503-511.
      • Kutsogiannis J, Alberda C, Gramlich L, Cahill NE, Wang M, Day AG, Dhaliwal R, Heyland DK. Early use of supplemental parenteral nutrition in critically ill patients: Results of an international multicenter observational study. Crit Care Med. 2011 Jul 14. [Epub ahead of print] PMID: 21765355.
      • Moore FA, Feliciano DV, Andrassy RJ, McArdle AH, Booth FV, MOrgenstein-Wagner T B, Kellum, JM, Welling RE and Moore EE. Early Enteral Feeding, Compared with Parenteral, Reduces Postoperative Septic Complications, The results of a Meta-analysis. Ann Surg, 1992, vol 16 (2) p 172-183
  • Search Plan and Results: CI: EN vs. PN 2011
     
  In adult patients who are critically ill, what is the effect of enteral nutrition (EN) vs. parenteral nutrition (PN) on cost of care?

  • Conclusion

    No new studies were identified in the update. When compared to PN, EN is associated with reduced cost of medical care in critically ill adult patients.

  • 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: In adult patients who are critically ill, what is the effect of enteral nutrition (EN) vs. parenteral nutrition (PN) on cost of care?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Abou-Assi S, Craig K, O'Keefe SJ. Hypocaloric jejunal feeding is better than total pareneteral nutrition in acute pancreatitis: results of a randomized comparative study. Am J Gastroenterol 2002; 97: 2,255-2,262.
      • Adams S, Dellinger EP, Wertz MJ, Oreskovich MR, Simonowitz D, Johansen K. J of Trauma; 1986;26(10);882-891
      • Borzotta, AP, et al. Enteral versus parenteral nutrition after severe closed head injury. J of Trauma. 1994;37(3):459-468.
      • Cerra FB, et al. Enteral nutrition does not prevent multiple organ failure syndrome (MOFS) after sepsis. Surgery. 1988;104:272-33.
      • Kalfarentzos, F, Kehagias N, Kokkinis MK, Gogos CA. Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial.  BJN; 1997, 84:1665-1669.
      • Trice S, Melnik G, Page G. Complications and costs of early postoperative parenteral versus enteral nurition in trauma patients. Nutrition in Clinical Practice 1997. 12 (3) 114-119.
  • Search Plan and Results: CI: EN vs. PN 2011