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.
      • Eyer SD, Micon LT, Konstantinides FN, et al. Early enteral feeding does not attenuate metabolic response after blunt trauma. J Trauma. 1993; 34: 5.
      • 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.
      • Ibrahim EH, et al. Early versus late enteral feeding of mechanically ventilated patients: results of a clinical trial. JPEN 2002; 26:174-181.
      • 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.
      • Lewis S., Egger M., Sylvester P., Thomas S. (2001). Early enteral feeding versus “nil by mouth” after gastrointestinal surgery:  systematic review and meta-analysis of controlled trials.  BMJ Vol 323 October: 773-776 (2001). 
      • Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: A systematic review. Crit Care Med. 2001; 29: 2,246-2,270.
      • Singh G, Ram RP, Khanna SK. Early postoperative enteral feeding in patients with nontraumatic intestinal perforation and peritonitis. J Am Coll Surg 1998; 187: 142-146.
      • 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: 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.
      • Eyer SD, Micon LT, Konstantinides FN, et al. Early enteral feeding does not attenuate metabolic response after blunt trauma. J Trauma. 1993; 34: 5.
      • Grahm TW, Zadrozny DB, Harrington T. The benefits of early jejeunal hyperalimentation in the head-injured patient. Neurosurgery 1989; 25: 729-735.
      • 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.
      • Ibrahim EH, et al. Early versus late enteral feeding of mechanically ventilated patients: results of a clinical trial. JPEN 2002; 26:174-181.
      • 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.
      • Lewis S., Egger M., Sylvester P., Thomas S. (2001). Early enteral feeding versus “nil by mouth” after gastrointestinal surgery:  systematic review and meta-analysis of controlled trials.  BMJ Vol 323 October: 773-776 (2001). 
      • Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: A systematic review. Crit Care Med. 2001; 29: 2,246-2,270.
      • Singh G, Ram RP, Khanna SK. Early postoperative enteral feeding in patients with nontraumatic intestinal perforation and peritonitis. J Am Coll Surg 1998; 187: 142-146.
      • 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: 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.
      • Eyer SD, Micon LT, Konstantinides FN, et al. Early enteral feeding does not attenuate metabolic response after blunt trauma. J Trauma. 1993; 34: 5.
      • Grahm TW, Zadrozny DB, Harrington T. The benefits of early jejeunal hyperalimentation in the head-injured patient. Neurosurgery 1989; 25: 729-735.
      • 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.
      • Ibrahim EH, et al. Early versus late enteral feeding of mechanically ventilated patients: results of a clinical trial. JPEN 2002; 26:174-181.
      • 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.
      • Kompan, L, Kremzar, B, Gadzijev, E, Prosek, M. Effects of early enteral nutrition on intestinal permeability and the development of multiple organ failure after multiple injury. Intensive Care Medicine. 1999; 25: 157-161.
      • 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.
      • Lewis S., Egger M., Sylvester P., Thomas S. (2001). Early enteral feeding versus “nil by mouth” after gastrointestinal surgery:  systematic review and meta-analysis of controlled trials.  BMJ Vol 323 October: 773-776 (2001). 
      • Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: A systematic review. Crit Care Med. 2001; 29: 2,246-2,270.
      • Singh G, Ram RP, Khanna SK. Early postoperative enteral feeding in patients with nontraumatic intestinal perforation and peritonitis. J Am Coll Surg 1998; 187: 142-146.
      • 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: Initiation of EN 2011