PURPOSE: To determine whether the provision of early standard enteral nutrition (EN) confers treatment benefits to critically ill patients. METHODS: Medline and EMBASE were searched. Hand citation review of retrieved guidelines and systematic reviews were undertaken, and academic and industry experts were contacted. Methodologically sound randomised controlled trials (RCTs) conducted in critically ill patient populations that compared the delivery of standard EN, provided within 24 h of intensive care unit (ICU) admission or injury, to standard care were included. The primary analysis was conducted on clinically meaningful patient-oriented outcomes. Secondary analyses considered vomiting/regurgitation, pneumonia, bacteraemia, sepsis and multiple organ dysfunction syndrome. Meta-analyses were conducted using the odds ratio (OR) metric and a fixed effects model. The impact of heterogeneity was assessed using the I (2) metric. RESULTS: Six RCTs with 234 participants were analysed. The provision of early EN was associated with a significant reduction in mortality [OR = 0.34, 95% confidence interval (CI) 0.14-0.85] and pneumonia (OR = 0.31, 95% CI 0.12-0.78). There were no other significant differences in outcomes. A sensitivity analysis and a simulation exercise confirmed the presence of a mortality reduction. CONCLUSION: Although the detection of a statistically significant reduction in mortality is promising, overall trial quality was low, trial size was small, and the findings may be restricted to the patient groups enrolled into included trials. The results of this meta-analysis should be confirmed by the conduct of a large multi-centre trial enrolling diverse critically ill patient groups.
PURPOSE: To determine whether the provision of early standard enteral nutrition (EN) confers treatment benefits to critically illpatients. METHODS: Medline and EMBASE were searched. Hand citation review of retrieved guidelines and systematic reviews were undertaken, and academic and industry experts were contacted. Methodologically sound randomised controlled trials (RCTs) conducted in critically illpatient populations that compared the delivery of standard EN, provided within 24 h of intensive care unit (ICU) admission or injury, to standard care were included. The primary analysis was conducted on clinically meaningful patient-oriented outcomes. Secondary analyses considered vomiting/regurgitation, pneumonia, bacteraemia, sepsis and multiple organ dysfunction syndrome. Meta-analyses were conducted using the odds ratio (OR) metric and a fixed effects model. The impact of heterogeneity was assessed using the I (2) metric. RESULTS: Six RCTs with 234 participants were analysed. The provision of early EN was associated with a significant reduction in mortality [OR = 0.34, 95% confidence interval (CI) 0.14-0.85] and pneumonia (OR = 0.31, 95% CI 0.12-0.78). There were no other significant differences in outcomes. A sensitivity analysis and a simulation exercise confirmed the presence of a mortality reduction. CONCLUSION: Although the detection of a statistically significant reduction in mortality is promising, overall trial quality was low, trial size was small, and the findings may be restricted to the patient groups enrolled into included trials. The results of this meta-analysis should be confirmed by the conduct of a large multi-centre trial enrolling diverse critically illpatient groups.
Authors: K G Kreymann; M M Berger; N E P Deutz; M Hiesmayr; P Jolliet; G Kazandjiev; G Nitenberg; G van den Berghe; J Wernerman; C Ebner; W Hartl; C Heymann; C Spies Journal: Clin Nutr Date: 2006-05-11 Impact factor: 7.324
Authors: M J Heslin; L Latkany; D Leung; A D Brooks; S N Hochwald; P W Pisters; M Shike; M F Brennan Journal: Ann Surg Date: 1997-10 Impact factor: 12.969
Authors: M Bernhard; G Marx; K Weismüller; C Lichtenstern; K Mayer; F M Brunkhorst; M A Weigand Journal: Anaesthesist Date: 2010-05 Impact factor: 1.041
Authors: Todd W Rice; Arthur P Wheeler; B Taylor Thompson; Jay Steingrub; R Duncan Hite; Marc Moss; Alan Morris; Ning Dong; Peter Rock Journal: JAMA Date: 2012-02-05 Impact factor: 56.272
Authors: Julie A Bastarache; Lorraine B Ware; Timothy D Girard; Arthur P Wheeler; Todd W Rice Journal: JPEN J Parenter Enteral Nutr Date: 2012-02-07 Impact factor: 4.016
Authors: Brodie A Parent; Samuel P Mandell; Ronald V Maier; Joseph Minei; Jason Sperry; Ernest E Moore; Grant E O'Keefe Journal: J Trauma Acute Care Surg Date: 2016-06 Impact factor: 3.313