Titre
Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines.
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Reintam Blaser, A.
Auteure/Auteur
Starkopf, J.
Auteure/Auteur
Alhazzani, W.
Auteure/Auteur
Berger, M.M.
Auteure/Auteur
Casaer, M.P.
Auteure/Auteur
Deane, A.M.
Auteure/Auteur
Fruhwald, S.
Auteure/Auteur
Hiesmayr, M.
Auteure/Auteur
Ichai, C.
Auteure/Auteur
Jakob, S.M.
Auteure/Auteur
Loudet, C.I.
Auteure/Auteur
Malbrain, M.L.
Auteure/Auteur
Montejo González, J.C.
Auteure/Auteur
Paugam-Burtz, C.
Auteure/Auteur
Poeze, M.
Auteure/Auteur
Preiser, J.C.
Auteure/Auteur
Singer, P.
Auteure/Auteur
van Zanten, A.R.
Auteure/Auteur
De Waele, J.
Auteure/Auteur
Wendon, J.
Auteure/Auteur
Wernerman, J.
Auteure/Auteur
Whitehouse, T.
Auteure/Auteur
Wilmer, A.
Auteure/Auteur
Oudemans-van Straaten, H.M.
Auteure/Auteur
Groupes de travail
ESICM Working Group on Gastrointestinal Function
Liens vers les personnes
Liens vers les unités
ISSN
1432-1238
Statut éditorial
Publié
Date de publication
2017-03
Volume
43
Numéro
3
Première page
380
Dernière page/numéro d’article
398
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Comparative Study ; Journal Article ; Meta-Analysis ; Practice Guideline ; Review
Publication Status: ppublish
Publication Status: ppublish
Résumé
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.
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.
PID Serval
serval:BIB_FCC094AEFBBE
PMID
Open Access
Oui
Date de création
2017-02-14T09:48:19.525Z
Date de création dans IRIS
2025-05-21T07:23:23Z
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Nom
s00134-016-4665-0.pdf
Version du manuscrit
published
Taille
2.36 MB
Format
Adobe PDF
PID Serval
serval:BIB_FCC094AEFBBE.P001
URN
urn:nbn:ch:serval-BIB_FCC094AEFBBE2
Somme de contrôle
(MD5):910c83797eea1ebd4247bdb9f8829dcd