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Early Enteral Nutrition Provided Within 24 Hours of ICU Admission: A Meta-Analysis of Randomized Controlled Trials
Feng Tian1, Philippa T Heighes, Matilde J Allingstrup
1All authors: Northern Clinical School Intensive Care Research Unit, University of Sydney, Sydney, NSW, Australia.
Insights
Early enteral nutrition (EEN) within 24 hours of ICU admission did not reduce overall mortality. However, EEN significantly lowered mortality and pneumonia risk compared to delayed intake in critically ill patients.
Area of Science:
- Critical care medicine
- Nutritional support
- Evidence synthesis
Background:
- Early enteral nutrition (EEN) is a common strategy in intensive care units (ICUs).
- Evidence regarding its impact on patient outcomes remains debated.
- Synthesizing current evidence is crucial for optimizing critical care nutrition.
Purpose of the Study:
- To evaluate the effect of early enteral nutrition (within 24 hours of ICU admission) on mortality and other patient outcomes.
- To compare EEN against all other forms of nutrition support.
- To investigate subgroup effects, particularly comparing EEN with delayed enteral intake and parenteral nutrition.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched Medline and Embase databases up to November 20, 2017.
- Included 16 RCTs with 3,225 critically ill adult participants.
Main Results:
- Overall, EEN did not reduce mortality compared to all other nutrition support (OR, 1.01; 95% CI, 0.86-1.18).
- Subgroup analysis showed EEN reduced mortality versus delayed enteral intake (OR, 0.45; 95% CI, 0.21-0.95) but not parenteral nutrition (OR, 1.04; 95% CI, 0.89-1.22).
- Patients receiving EEN had a lower incidence of pneumonia (OR, 0.75; 95% CI, 0.60-0.94).
Conclusions:
- Early enteral nutrition (within 24 hours) shows no overall mortality benefit compared to other nutrition support methods.
- EEN significantly reduces mortality and pneumonia when compared specifically to delayed enteral intake.
- No clear clinical advantages of EEN over parenteral nutrition were identified in this analysis.
Objectives:
To identify, appraise, and synthesize the most current evidence to determine whether early enteral nutrition alters patient outcomes from critical illness.
Data Sources:
Medline and Embase were searched. The close out date was November 20, 2017.
Study Selection:
Early enteral nutrition was defined as a standard formula commenced within 24 hours of ICU admission. Comparators included any form of nutrition support "except" early enteral nutrition. Only randomized controlled trials conducted in adult patients requiring treatment in an ICU were eligible for inclusion.
Data Extraction:
The primary outcome was mortality. Secondary outcomes included pneumonia, duration of mechanical ventilation, and ICU and hospital stay.
Data Synthesis:
Six-hundred ninety-nine full-text articles were retrieved and screened. Sixteen randomized controlled trials enrolling 3,225 critically ill participants were included. Compared with all other types of nutrition support, commencing enteral nutrition within 24 hours of ICU admission did not result in a reduction in mortality (odds ratio, 1.01; 95% CI, 0.86-1.18; p = 0.91; I = 32%). However, there was a differential treatment effect between a priori identified subgroups (p = 0.032): early enteral nutrition reduced mortality compared with delayed enteral intake (odds ratio, 0.45; 95% CI, 0.21-0.95; p = 0.038; I = 0%), whereas a mortality difference was not detected between early enteral nutrition and parenteral nutrition (odds ratio, 1.04; 95% CI, 0.89-1.22; p = 0.58; I = 30%). Overall, patients who were randomized to receive early enteral nutrition were less likely to develop pneumonia (odds ratio, 0.75; 95% CI, 0.60-0.94; p = 0.012; I = 48%).
Conclusions:
Overall, there was no difference between early enteral nutrition and all other forms of nutrition support. A priori planned subgroup analysis revealed early enteral nutrition reduced mortality and pneumonia compared with delayed enteral intake; however, there were no clear clinical advantages of early enteral nutrition over parenteral nutrition.
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