TY - JOUR
T1 - Early enteral nutrition in critically ill patients
T2 - ESICM clinical practice guidelines
AU - Blaser, Annika Reintam
AU - Starkopf, Joel
AU - Alhazzani, Waleed
AU - Berger, Mette M.
AU - Casaer, Michael P.
AU - Deane, Adam M.
AU - Fruhwald, Sonja
AU - Hiesmayr, Michael
AU - Ichai, Carole
AU - Jakob, Stephan M.
AU - Loudet, Cecilia I.
AU - Malbrain, Manu L. N. G.
AU - Gonzalez, Juan C. Montejo
AU - Paugam-Burtz, Catherine
AU - Poeze, Martijn
AU - Preiser, Jean-Charles
AU - Singer, Pierre
AU - Van Zanten, Arthur R. H.
AU - De Waele, Jan
AU - Wendon, Julia
AU - Wernerman, Jan
AU - Whitehouse, Tony
AU - Wilmer, Alexander
AU - Oudemans-van Straaten, Heleen M.
PY - 2017/3
Y1 - 2017/3
N2 - To provide evidence-based guidelines for early enteral nutrition (EEN) during critical illness.We aimed to compare EEN vs. early parenteral nutrition (PN) and vs. delayed EN. We defined "early" EN as EN started within 48 h independent of type or amount. We listed, a priori, conditions in which EN is often delayed, and performed systematic reviews in 24 such subtopics. If sufficient evidence was available, we performed meta-analyses; if not, we qualitatively summarized the evidence and based our recommendations on expert opinion. We used the GRADE approach for guideline development. The final recommendations were compiled via Delphi rounds.We formulated 17 recommendations favouring initiation of EEN and seven recommendations favouring delaying EN. We performed five meta-analyses: in unselected critically ill patients, and specifically in traumatic brain injury, severe acute pancreatitis, gastrointestinal (GI) surgery and abdominal trauma. EEN reduced infectious complications in unselected critically ill patients, in patients with severe acute pancreatitis, and after GI surgery. We did not detect any evidence of superiority for early PN or delayed EN over EEN. All recommendations are weak because of the low quality of evidence, with several based only on expert opinion.We suggest using EEN in the majority of critically ill under certain precautions. In the absence of evidence, we suggest delaying EN in critically ill patients with uncontrolled shock, uncontrolled hypoxaemia and acidosis, uncontrolled upper GI bleeding, gastric aspirate > 500 ml/6 h, bowel ischaemia, bowel obstruction, abdominal compartment syndrome, and high-output fistula without distal feeding access.
AB - To provide evidence-based guidelines for early enteral nutrition (EEN) during critical illness.We aimed to compare EEN vs. early parenteral nutrition (PN) and vs. delayed EN. We defined "early" EN as EN started within 48 h independent of type or amount. We listed, a priori, conditions in which EN is often delayed, and performed systematic reviews in 24 such subtopics. If sufficient evidence was available, we performed meta-analyses; if not, we qualitatively summarized the evidence and based our recommendations on expert opinion. We used the GRADE approach for guideline development. The final recommendations were compiled via Delphi rounds.We formulated 17 recommendations favouring initiation of EEN and seven recommendations favouring delaying EN. We performed five meta-analyses: in unselected critically ill patients, and specifically in traumatic brain injury, severe acute pancreatitis, gastrointestinal (GI) surgery and abdominal trauma. EEN reduced infectious complications in unselected critically ill patients, in patients with severe acute pancreatitis, and after GI surgery. We did not detect any evidence of superiority for early PN or delayed EN over EEN. All recommendations are weak because of the low quality of evidence, with several based only on expert opinion.We suggest using EEN in the majority of critically ill under certain precautions. In the absence of evidence, we suggest delaying EN in critically ill patients with uncontrolled shock, uncontrolled hypoxaemia and acidosis, uncontrolled upper GI bleeding, gastric aspirate > 500 ml/6 h, bowel ischaemia, bowel obstruction, abdominal compartment syndrome, and high-output fistula without distal feeding access.
KW - Abdominal problems
KW - Parenteral nutrition
KW - Contraindications
KW - GI symptoms
KW - Early enteral nutrition
KW - Delay of enteral nutrition
KW - INTENSIVE-CARE-UNIT
KW - SEVERE ACUTE-PANCREATITIS
KW - MECHANICALLY VENTILATED PATIENTS
KW - RANDOMIZED CONTROLLED-TRIAL
KW - STRESS-ULCER PROPHYLAXIS
KW - THERAPEUTIC HYPOTHERMIA
KW - INTRAABDOMINAL HYPERTENSION
KW - GASTROINTESTINAL SURGERY
KW - PARENTERAL-NUTRITION
KW - VASOPRESSOR THERAPY
U2 - 10.1007/s00134-016-4665-0
DO - 10.1007/s00134-016-4665-0
M3 - Article
C2 - 28168570
SN - 0342-4642
VL - 43
SP - 380
EP - 398
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 3
ER -