Critical Illness

CI: Initiation of Enteral Nutrition (2012)

• Intervention
  In adult patients who are critically ill, does the the early vs. delayed initiation of enteral nutrition (EN) impact mortality?

  • Conclusion

    Evidence that early enteral nutrition (EEN) affects mortality in critically-ill adult patients is inconsistent.

  • 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, does the early vs. delayed initiation of enteral nutrition (EN) impact mortality?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Dissanaike S, Pham T, Shalhub S, WArner K, Hennessy L, Moore EE, Maier RV, O'Keefe GE, Cuschieri J. Effect of immediate enteral feeding on trauma patients with an open abdomen: Protection from nosocomial infections. J Am Coll Surg. 2008 Nov; 207 (5): 690-697. PMID 18954781.
      • Doig GS, Heighes PT, Simpson F, Sweetman EA, Davies AR. Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta-analysis of randomised controlled trials. Intensive Care Med. 2009; 35 (12): 2, 018-2,027.
      • Doig GS, Simpson F, Finfer S, Delaney A, Davies AR, Mitchell I, Dobb G. Nutrition Guidelines Investigators of the ANZICS Clinical Trials Group. Effect of evidence-based feeding guidelines on mortality of critically ill adults: A cluster randomized controlled trial. JAMA. 2008 Dec 17; 300 (23): 2,731-2,732. PMID: 19088351.
      • Doig GS, Heighes PT, Simpson F, Sweetman EA. Early enteral nutrition reduces mortality in trauma patients requiring intensive care: A meta-analysis of randomised controlled trials. Injury. 2011 Jan; 42(1): 50-56.
      • 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.
      • Khalid I, Doshi P, DiGiovine B. Early enteral nutrition and outcomes of critically ill patients treated with vasopressors and mechanical ventilation. Am J Crit Care. 2010 May; 19 (3): 261-268. Erratum in: Am J Crit Care. 2010 Nov; 19 (6): 488. PMID: 20436064.
  • Search Plan and Results: CI: Initiation of EN 2011
     
  In adult patients who are critically ill, does the early vs. delayed initiation of enteral nutrition (EN) impact infectious complications?

  • Conclusion

    In fluid-resuscitated, critically-ill adult patients, early enteral nutrition (EEN) reduces the incidence of infectious complications.

  • 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, does the early vs. late initiation of enteral nutrition (EN) impact infectious complications?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Dissanaike S, Pham T, Shalhub S, WArner K, Hennessy L, Moore EE, Maier RV, O'Keefe GE, Cuschieri J. Effect of immediate enteral feeding on trauma patients with an open abdomen: Protection from nosocomial infections. J Am Coll Surg. 2008 Nov; 207 (5): 690-697. PMID 18954781.
      • Doig GS, Heighes PT, Simpson F, Sweetman EA, Davies AR. Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta-analysis of randomised controlled trials. Intensive Care Med. 2009; 35 (12): 2, 018-2,027.
      • Doig GS, Heighes PT, Simpson F, Sweetman EA. Early enteral nutrition reduces mortality in trauma patients requiring intensive care: A meta-analysis of randomised controlled trials. Injury. 2011 Jan; 42(1): 50-56.
      • 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.
  • Search Plan and Results: CI: Initiation of EN 2011
     
  In adult patients who are critically ill, does the early vs. delayed initiation of enteral nutrition (EN) impact length of hospital stay (LOS)?

  • Conclusion

    Evidence that early enteral nutrition (EEN) reduces LOS in critically-ill adult patients is inconsistent.

  • 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, does the early vs. delayed initiation of enteral nutrition (EN) impact length of hospital stay (LOS)?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Dissanaike S, Pham T, Shalhub S, WArner K, Hennessy L, Moore EE, Maier RV, O'Keefe GE, Cuschieri J. Effect of immediate enteral feeding on trauma patients with an open abdomen: Protection from nosocomial infections. J Am Coll Surg. 2008 Nov; 207 (5): 690-697. PMID 18954781.
      • Doig GS, Simpson F, Finfer S, Delaney A, Davies AR, Mitchell I, Dobb G. Nutrition Guidelines Investigators of the ANZICS Clinical Trials Group. Effect of evidence-based feeding guidelines on mortality of critically ill adults: A cluster randomized controlled trial. JAMA. 2008 Dec 17; 300 (23): 2,731-2,732. PMID: 19088351.
      • 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.
      • Khalid I, Doshi P, DiGiovine B. Early enteral nutrition and outcomes of critically ill patients treated with vasopressors and mechanical ventilation. Am J Crit Care. 2010 May; 19 (3): 261-268. Erratum in: Am J Crit Care. 2010 Nov; 19 (6): 488. PMID: 20436064.
  • Search Plan and Results: CI: Initiation of EN 2011