Early Enteral Group Research Articles

Early enteral nutrition (within 48 hours) versus delayed enteral nutrition (after 48 hours) with or without supplemental parenteral nutrition in critically ill adults.

Early enteral nutrition support (within 48 hours of admission or injury) is frequently recommended for the management of patients in intensive care units (ICU). Early enteral nutrition is recommended in many clinical practice guidelines, although there appears to be a lack of evidence for its use and benefit. To evaluate the efficacy and safety of early enteral nutrition (initiated within 48 hours of initial injury or ICU admission) versus delayed enteral nutrition (initiated later than 48 hours after initial injury or ICU admission), with or without supplemental parenteral nutrition, in critically ill adults. We searched CENTRAL (2019, Issue 4), MEDLINE Ovid (1946 to April 2019), Embase Ovid SP (1974 to April 2019), CINAHL EBSCO (1982 to April 2019), and ISI Web of Science (1945 to April 2019). We also searched Turning Research Into Practice (TRIP), trial registers (ClinicalTrials.gov, ISRCTN registry), and scientific conference reports, including the American Society for Parenteral and Enteral Nutrition and the European Society for Clinical Nutrition and Metabolism. We applied no restrictions by language or publication status. We included all randomized controlled trials (RCTs) that compared early versus delayed enteral nutrition, with or without supplemental parenteral nutrition, in adults who were in the ICU for longer than 72 hours. This includedindividuals admitted for medical, surgical, and trauma diagnoses, and who required any type of enteral nutrition. Two review authors extracted study data and assessed the risk of bias in the included studies. We expressed results as risk ratios (RR) for dichotomous data, and as mean differences (MD) for continuous data, both with 95% confidence intervals (CI). We assessed the certainty of the evidence using GRADE. We included seven RCTs with a total of 345 participants. Outcome data were limited, and we judged many trials to have an unclear risk of bias in several domains. Early versus delayed enteral nutrition Six trials (318 participants) assessed early versus delayed enteral nutrition in general, medical, and trauma ICUs in the USA, Australia, Greece, India, and Russia. Primary outcomes Five studies (259 participants) measured mortality. It is uncertain whether early enteral nutrition affects the risk of mortality within 30 days (RR 1.00, 95% CI 0.16 to 6.38; 1 study, 38 participants; very low-quality evidence). Four studies (221 participants) reported mortality without describing the timeframe; we did not pool these results. None of the studies reported a clear difference in mortality between groups. Three studies (156 participants) reported infectious complications. We were unable to pool the results due to unreported data and substantial clinical heterogeneity. The results were inconsistent across studies. One trial measured feed intolerance or gastrointestinal complications; it is uncertain whether early enteral nutrition affects this outcome (RR 0.84, 95% CI 0.35 to 2.01; 59 participants; very low-quality evidence). Secondary outcomes One trial assessed hospital length of stay and reported a longer stay in the early enteral group (median 15 days (interquartile range (IQR) 9.5 to 20) versus 12 days (IQR 7.5 to15); P = 0.05; 59 participants; very low-quality evidence). Three studies (125 participants) reported the duration of mechanical ventilation. We did not pool the results due to clinical and statistical heterogeneity. The results were inconsistent across studies. It is uncertain whether early enteral nutrition affects the risk of pneumonia (RR 0.77, 95% CI 0.55 to 1.06; 4 studies, 192 participants; very low-quality evidence). Early enteral nutrition with supplemental parenteral nutrition versus delayed enteral nutrition with supplemental parenteral nutrition We identified one trial in a burn ICU in the USA (27 participants). Primary outcomes It is uncertain whether early enteral nutrition with supplemental parenteral nutrition affects the risk of mortality (RR 0.74, 95% CI 0.25 to 2.18; very low-quality evidence), or infectious complications (MD 0.00, 95% CI -1.94 to 1.94; very low-quality evidence). There were no data available for feed intolerance or gastrointestinal complications. Secondary outcomes It is uncertain whether early enteral nutrition with supplemental parenteral nutrition reduces the duration of mechanical ventilation (MD 9.00, 95% CI -10.99 to 28.99; very low-quality evidence). There were no data available for hospital length of stay or pneumonia. Due to very low-quality evidence, we are uncertain whether early enteral nutrition, compared with delayed enteral nutrition, affects the risk of mortality within 30 days, feed intolerance or gastrointestinal complications, or pneumonia. Due to very low-quality evidence, we are uncertain if early enteral nutrition with supplemental parenteral nutrition compared with delayed enteral nutrition with supplemental parenteral nutrition reduces mortality, infectious complications, or duration of mechanical ventilation. There is currently insufficient evidence; there is a need for large, multicentred studies with rigorous methodology, which measure important clinical outcomes.

Enteral Nutritional Support in Patients with Head Injuries After Craniocerebral Surgery.

To explore the effect of early enteral (EN) and parenteral nutritional (PN) support on head-injured patients after craniocerebral surgery. We randomly divided 120 head trauma patients into two groups: those receiving EN and those receiving PN support (60 patients each). Physiological and biochemical indices, monitoring time and cost, and the incidence of complications were compared between the two groups. More patients presented with complications in the PN than the EN group, and this difference was statistically significant (P < 0.05). One week after surgery, albumin (ALB), alanine aminotransferase (ALT), and blood glucose (GLU) levels were 39.6 ± 3.3 U/L, 51.4 ± 5.6 U/L, and 9.6 ± 5.2 mmol/L, respectively, in the EN group, and monitoring time and cost were 4.0 ± 1.2 days and 1.2 ± 1.0 thousand yuan, respectively. In the PN group, ALB, ALT, and GLU levels were 34.3 ± 3.4 U/L, 65.5 ± 6.1 U/L, and 15.1 ± 4.0 mmol/L, respectively, and monitoring time and cost were 6.2 ± 1.5 days and 1.8 ± 2.0 thousand yuan, respectively. We detected significant differences between the two groups (P < 0.05). Early EN support is superior to PN support in head-injured patients after craniocerebral surgery.

Enteral or parenteral nutrition in traumatic brain injury: a prospective randomised trial.

Few studies have evaluated the route of nutritional therapy in patients with head trauma. We aimed at investigating whether early enteral (EN) or parenteral nutrition (TPN) may differ in protein/ calorie supply, serum glucose modifications, and acute phase response in patients with traumatic brain injury (TBI). Twenty two patients with moderate TBI (Glasgow score between 9-12) were randomized to receive isocaloric and isonitrogeneous either EN (n=12) or TPN (n=10). The daily amount of calories and nitrogen (N) supplied, the nitrogen balance, and the daily serum level of glucose, C-reactive protein, and albumin were collected for 5 consecutive days. Clinical endpoints as length of stay and mortality were also compared. Mortality was 9.1% (two cases) with one case in each group. A progressive caloric deficit occurred in both groups (p=0.001) without difference between them. The mean serum glucose level in TNP patients (134.4, 95% CI=122.6 to 146.2 mg/dl) was significantly higher than in the EN group (102,4; 95% CI 91.6 to 113.2 mg/dL) (p<0.001). There was a trend (p=0.06) of 24 h urinary N loss to be greater in TPN group which received higher amounts of N than the NE group (p<0.05). However, nitrogen balance was similar in the two groups. There was no difference in either the clinical outcome variables or the acute phase response. Both routes were able to supply increasing provision of calories to brain injured patients. TPN provided significantly greater amount of nitrogen but losses were also greater. Nitrogen balance was similar with both types of therapy. Parenteral compared to enteral nutrition lead to greater hyperglycemia. There was no influence of the route in both the early inflammatory response and clinical outcome.

Nutrición enteral o parenteral en lesión traumática cerebral: un estudio prospectivo y randomizado

Introduction - Few studies have evaluated the route of nutritional therapy in patients with head trauma. Objective – We aimed at investigating whether early enteral (EN) or parenteral nutrition (TPN) may differ in protein/ calorie supply, serum glucose modifications, and acute phase response in patients with traumatic brain injury (TBI). Methods – Twenty two patients with moderate TBI (Glasgow score between 9-12) were randomized to receive isocaloric and isonitrogeneous either EN (n=12) or TPN (n=10). The daily amount of calories and nitrogen (N) supplied, the nitrogen balance, and the daily serum level of glucose, C-reactive protein, and albumin were collected for 5 consecutive days. Clinical endpoints as length of stay and mortality were also compared. Results – Mortality was 9.1% (two cases) with one case in each group. A progressive caloric deficit occurred in both groups (p = 0.001) without difference between them. The mean serum glucose level in TNP patients (134.4, 95% CI = 122.6 to 146.2 mg / dl) was significantly higher than in the EN group (102,4; 95% CI 91.6 to 113.2 mg / dL) (p <0.001). There was a significant trend (p = 0.06) of 24h urinary N loss to be greater in TPN group which received higher amounts of N than the NE group (p<0.05). However, nitrogen balance was similar in the two groups. There was no difference in either the clinical outcome variables or the acute phase response. Conclusion – Both routes were able to supply increasing provision of calories to brain injured patients. TPN provided significantly greater amount of nitrogen but losses were also greater. Nitrogen balance was similar with both types of therapy. Parenteral compared to enteral nutrition lead to greater hyperglycemia. There was no influence of the route in both the early inflammatory response and clinical outcome.

Early enteral feeding for burned patients—An effective method which should be encouraged in developing countries

A randomized control trial was conducted to investigate impact of early enteral feeding on immune, metabolic aspects and outcomes of 82 severe burned patients admitting to National Institute of Burns, Hanoi, Vietnam from November 2003 to November 2004. Fourty-one patients were in early enteral group and 41 patients were in total parenteral nutrition group. Blood samples were collected at admission and 7th day postburn to determine plasma level of IgG, IgM, insulin, corrtisol and blood absolute number of TCD4, TCD8. Intestinal chyme was drawn through a weighted feeding tube to determine intestinal secreted IgA. Results showed that, at the 7th day after burn, both humoral and cellular immunology recovered faster in enteral nutrition group as compared to total parenteral group ( p < 0.05). In the early enteral nutrition group, after 1 week, plasma concentration of cortisol decreased from 599.70 to 437 nmol/l and that of insulin increased from 12.07 to 30.34 μmol/ml. Vice versa, in the control group the change was in the reverse direction ( p < 0.01). Overall complication decreased in the enteral nutrition group in comparison with parenteral group. Finally, mortality was significantly lower in early enteral nutrition group as compared to the parenteral group (14.65% and 36.58%, respectively). In conclusion, early enteral nutrition after burn has positive effects on immune and metabolic function, and reduces complication as well as death rate.