TY - JOUR
T1 - Early Enteral Nutrition (within 48 h) for Patients with Sepsis or Septic Shock
T2 - A Systematic Review and Meta-Analysis
AU - Grillo-Ardila, Carlos F.
AU - Tibavizco-Palacios , Diego
AU - Triana Moreno, Luis Carlos
AU - Rugeles, Saul
AU - Vallejo-Ortega, María T.
AU - Calderón-Franco, Carlos H.
AU - Ramírez-Mosquera, Juan J.
PY - 2024/5/22
Y1 - 2024/5/22
N2 - OBJECTIVE: Medical nutrition therapy provides the opportunity to compensate for muscle wasting and immune response activation during stress and trauma. The objective of this systematic review is to assess the safety and effectiveness of early enteral nutrition (EEN) in adults with sepsis or septic shock. METHODS: The MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, and ICTRP tools were searched from inception until July 2023. Conference proceedings, the reference lists of included studies, and expert content were queried to identify additional publications. Two review authors completed the study selection, data extraction, and risk of bias assessment; disagreements were resolved through discussion. Inclusion criteria were randomized controlled trials (RCTs) and non-randomized studies (NRSs) comparing the administration of EEN with no or delayed enteral nutrition (DEE) in adult populations with sepsis or septic shock. RESULTS: Five RCTs (n = 442 participants) and ten NRSs (n = 3724 participants) were included. Low-certainty evidence from RCTs and NRSs suggests that patients receiving EEN could require fewer days of mechanical ventilation (MD -2.65; 95% CI, -4.44-0.86; and MD -2.94; 95% CI, -3.64--2.23, respectively) and may show lower SOFA scores during follow-up (MD -1.64 points; 95% CI, -2.60--0.68; and MD -1.08 points; 95% CI, -1.90--0.26, respectively), albeit with an increased frequency of diarrhea episodes (OR 2.23, 95% CI 1.115-4.34). Even though the patients with EEN show a lower in-hospital mortality rate both in RCTs (OR 0.69; 95% CI, 0.39-1.23) and NRSs (OR 0.89; 95% CI, 0.69-1.13), this difference does not achieve statistical significance. There were no apparent differences for other outcomes. CONCLUSIONS: Low-quality evidence suggests that EEN may be a safe and effective intervention for the management of critically ill patients with sepsis or septic shock.
AB - OBJECTIVE: Medical nutrition therapy provides the opportunity to compensate for muscle wasting and immune response activation during stress and trauma. The objective of this systematic review is to assess the safety and effectiveness of early enteral nutrition (EEN) in adults with sepsis or septic shock. METHODS: The MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, and ICTRP tools were searched from inception until July 2023. Conference proceedings, the reference lists of included studies, and expert content were queried to identify additional publications. Two review authors completed the study selection, data extraction, and risk of bias assessment; disagreements were resolved through discussion. Inclusion criteria were randomized controlled trials (RCTs) and non-randomized studies (NRSs) comparing the administration of EEN with no or delayed enteral nutrition (DEE) in adult populations with sepsis or septic shock. RESULTS: Five RCTs (n = 442 participants) and ten NRSs (n = 3724 participants) were included. Low-certainty evidence from RCTs and NRSs suggests that patients receiving EEN could require fewer days of mechanical ventilation (MD -2.65; 95% CI, -4.44-0.86; and MD -2.94; 95% CI, -3.64--2.23, respectively) and may show lower SOFA scores during follow-up (MD -1.64 points; 95% CI, -2.60--0.68; and MD -1.08 points; 95% CI, -1.90--0.26, respectively), albeit with an increased frequency of diarrhea episodes (OR 2.23, 95% CI 1.115-4.34). Even though the patients with EEN show a lower in-hospital mortality rate both in RCTs (OR 0.69; 95% CI, 0.39-1.23) and NRSs (OR 0.89; 95% CI, 0.69-1.13), this difference does not achieve statistical significance. There were no apparent differences for other outcomes. CONCLUSIONS: Low-quality evidence suggests that EEN may be a safe and effective intervention for the management of critically ill patients with sepsis or septic shock.
KW - Cuidado Crítico
KW - Nutricion Enteal
KW - sepsis
KW - enteral nutrition
KW - critical care
KW - systematic review
KW - Shock, Septic/therapy
KW - Enteral Nutrition/methods
KW - Time Factors
KW - Humans
KW - Treatment Outcome
KW - Sepsis/therapy
KW - Respiration, Artificial
KW - Randomized Controlled Trials as Topic
UR - http://www.scopus.com/inward/record.url?scp=85196600706&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/c7ce332b-e8bc-3d0e-9252-9d276baa36b2/
UR - https://perfilesycapacidades.javeriana.edu.co/en/publications/0dde30d8-f63d-4cf8-9444-b16fd956ed75
U2 - 10.3390/nu16111560
DO - 10.3390/nu16111560
M3 - Review article
C2 - 38892494
AN - SCOPUS:85196600706
SN - 2072-6643
VL - 16
SP - 1
EP - 11
JO - Nutrients
JF - Nutrients
IS - 11
ER -