Intensive Care Medicine

, Volume 35, Issue 12, pp 2018–2027

Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta-analysis of randomised controlled trials

  • Gordon S. Doig
  • Philippa T. Heighes
  • Fiona Simpson
  • Elizabeth A. Sweetman
  • Andrew R. Davies
Systematic Review

DOI: 10.1007/s00134-009-1664-4

Cite this article as:
Doig, G.S., Heighes, P.T., Simpson, F. et al. Intensive Care Med (2009) 35: 2018. doi:10.1007/s00134-009-1664-4

Abstract

Purpose

To determine whether the provision of early standard enteral nutrition (EN) confers treatment benefits to critically ill patients.

Methods

Medline and EMBASE were searched. Hand citation review of retrieved guidelines and systematic reviews were undertaken, and academic and industry experts were contacted.

Methodologically sound randomised controlled trials (RCTs) conducted in critically ill patient populations that compared the delivery of standard EN, provided within 24 h of intensive care unit (ICU) admission or injury, to standard care were included.

The primary analysis was conducted on clinically meaningful patient-oriented outcomes. Secondary analyses considered vomiting/regurgitation, pneumonia, bacteraemia, sepsis and multiple organ dysfunction syndrome. Meta-analyses were conducted using the odds ratio (OR) metric and a fixed effects model. The impact of heterogeneity was assessed using the I2 metric.

Results

Six RCTs with 234 participants were analysed. The provision of early EN was associated with a significant reduction in mortality [OR = 0.34, 95% confidence interval (CI) 0.14–0.85] and pneumonia (OR = 0.31, 95% CI 0.12–0.78). There were no other significant differences in outcomes. A sensitivity analysis and a simulation exercise confirmed the presence of a mortality reduction.

Conclusion

Although the detection of a statistically significant reduction in mortality is promising, overall trial quality was low, trial size was small, and the findings may be restricted to the patient groups enrolled into included trials. The results of this meta-analysis should be confirmed by the conduct of a large multi-centre trial enrolling diverse critically ill patient groups.

Keywords

Early enteral nutrition Critical illness Intensive care unit Meta-analysis Systematic review 

Copyright information

© Copyright jointly hold by Springer and ESICM 2009

Authors and Affiliations

  • Gordon S. Doig
    • 1
    • 2
  • Philippa T. Heighes
    • 2
  • Fiona Simpson
    • 2
  • Elizabeth A. Sweetman
    • 2
  • Andrew R. Davies
    • 3
  1. 1.Northern Clinical SchoolUniversity of SydneySydneyAustralia
  2. 2.Royal North Shore Hospital, Intensive Care UnitSt. LeonardsAustralia
  3. 3.The Alfred Hospital, Intensive Care UnitMelbourneAustralia