Critical Illness

CI: Timing of Enteral Nutrition (2006)

• Intervention
  Does the timing of enteral feeding impact the mortality of critically ill patients?

  • Conclusion

    To date, adequately powered studies have not been conducted to demonstrate a significant difference in mortality when comparing early vs. late EN 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: Does the timing of enteral feeding impact the mortality of critically ill patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • 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.
      • 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.
      • Minard G, Kudsk KA, Melton S, Patton JH, Tolley EA. Early versus delayed feeding with an immune-enhancing diet in patients with severe head injuries. Journal of Parenteral and Enteral Nutrition. 2000; 24: 1,445-1,449.
      • 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.
      • Yanagawa T, Bunn F, Roberts I, Wentz R, Pierro A. Nutritional support for head-injured patients (Cochrane Review). Cochrane Database Syst Rev. 2002; (3): CD001530. Review.
  • Search Plan and Results: CI: Timing of Enteral Nutrition 2003
     
  Does the timing of enteral feeding impact infectious complications in critically ill patients?

  • Conclusion

    In fluid-resuscitated, critically ill patients, EN started within 24-48 hours following injury or admission to the ICU 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: Does the timing of enteral feeding impact infectious complications in critically ill patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • 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.
      • Minard G, Kudsk KA, Melton S, Patton JH, Tolley EA. Early versus delayed feeding with an immune-enhancing diet in patients with severe head injuries. Journal of Parenteral and Enteral Nutrition. 2000; 24: 1,445-1,449.
      • Moore, E, Jones, T. Benefits of immediate jejunostomy feeding after major abdominal trauma: A prospective, randomized study, The Journal of Trauma 26.19 (1986): 874-881.
      • 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.
      • Yanagawa T, Bunn F, Roberts I, Wentz R, Pierro A. Nutritional support for head-injured patients (Cochrane Review). Cochrane Database Syst Rev. 2002; (3): CD001530. Review.
  • Search Plan and Results: CI: Timing of Enteral Nutrition 2003
     
  Does the timing of enteral feeding impact the length of hospital stay in critically ill patients?

  • Conclusion

    In fluid-resuscitated, critically ill patients, EN started within 24-48 hours following injury or admission to the ICU may reduce LOS.

  • 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: Does the timing of enteral feeding impact the length of hospital stay in critically ill patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • 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.
      • 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.
      • Minard G, Kudsk KA, Melton S, Patton JH, Tolley EA. Early versus delayed feeding with an immune-enhancing diet in patients with severe head injuries. Journal of Parenteral and Enteral Nutrition. 2000; 24: 1,445-1,449.
      • Moore, E, Jones, T. Benefits of immediate jejunostomy feeding after major abdominal trauma: A prospective, randomized study, The Journal of Trauma 26.19 (1986): 874-881.
      • 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.
      • 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.
      • Yanagawa T, Bunn F, Roberts I, Wentz R, Pierro A. Nutritional support for head-injured patients (Cochrane Review). Cochrane Database Syst Rev. 2002; (3): CD001530. Review.
  • Search Plan and Results: CI: Timing of Enteral Nutrition 2003