Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines

Annika Reintam Blaser; Joel Starkopf; Waleed Alhazzani; Mette M. Berger; Michael P. Casaer; Adam M. Deane; Sonja Fruhwald; Michael Hiesmayr; Carole Ichai; Stephan M. Jakob; Cecilia I. Loudet; Manu L N G Malbrain; Juan C. Montejo González; Catherine Paugam-Burtz; Martijn Poeze; Jean Charles Preiser; Pierre Singer; Arthur R H van Zanten; Jan De Waele; Julia Wendon; Jan Wernerman; Tony Whitehouse; Alexander Wilmer; Heleen M. Oudemans-van Straaten

doi:10.1007/s00134-016-4665-0

Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines

Annika Reintam Blaser^*, Joel Starkopf, Waleed Alhazzani, Mette M. Berger, Michael P. Casaer, Adam M. Deane, Sonja Fruhwald, Michael Hiesmayr, Carole Ichai, Stephan M. Jakob, Cecilia I. Loudet, Manu L N G Malbrain, Juan C. Montejo González, Catherine Paugam-Burtz, Martijn Poeze, Jean Charles Preiser, Pierre Singer, Arthur R H van Zanten, Jan De Waele, Julia WendonJan Wernerman, Tony Whitehouse, Alexander Wilmer, Heleen M. Oudemans-van Straaten

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

609 Citations (Scopus)

Abstract

Purpose: To provide evidence-based guidelines for early enteral nutrition (EEN) during critical illness. Methods: 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. Results: 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. Conclusions: 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.

Original language	English
Pages (from-to)	380-398
Number of pages	19
Journal	Intensive Care Medicine
Volume	43
Issue number	3
DOIs	https://doi.org/10.1007/s00134-016-4665-0
Publication status	Published - 1 Mar 2017

Keywords

Abdominal problems
Contraindications
Delay of enteral nutrition
Early enteral nutrition
GI symptoms
Parenteral nutrition

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10.1007/s00134-016-4665-0

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Reintam Blaser, A., Starkopf, J., Alhazzani, W., Berger, M. M., Casaer, M. P., Deane, A. M., Fruhwald, S., Hiesmayr, M., Ichai, C., Jakob, S. M., Loudet, C. I., Malbrain, M. L. N. G., Montejo González, J. C., Paugam-Burtz, C., Poeze, M., Preiser, J. C., Singer, P., van Zanten, A. R. H., De Waele, J., ... Oudemans-van Straaten, H. M. (2017). Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Medicine, 43(3), 380-398. https://doi.org/10.1007/s00134-016-4665-0

@article{a9c594e73eac48f7a4c1afa75244d6bc,

title = "Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines",

abstract = "Purpose: To provide evidence-based guidelines for early enteral nutrition (EEN) during critical illness. Methods: 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. Results: 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. Conclusions: 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.",

keywords = "Abdominal problems, Contraindications, Delay of enteral nutrition, Early enteral nutrition, GI symptoms, Parenteral nutrition",

author = "{Reintam Blaser}, Annika and Joel Starkopf and Waleed Alhazzani and Berger, {Mette M.} and Casaer, {Michael P.} and Deane, {Adam M.} and Sonja Fruhwald and Michael Hiesmayr and Carole Ichai and Jakob, {Stephan M.} and Loudet, {Cecilia I.} and Malbrain, {Manu L N G} and {Montejo Gonz{\'a}lez}, {Juan C.} and Catherine Paugam-Burtz and Martijn Poeze and Preiser, {Jean Charles} and Pierre Singer and {van Zanten}, {Arthur R H} and {De Waele}, Jan and Julia Wendon and Jan Wernerman and Tony Whitehouse and Alexander Wilmer and {Oudemans-van Straaten}, {Heleen M.}",

year = "2017",

month = mar,

day = "1",

doi = "10.1007/s00134-016-4665-0",

language = "English",

volume = "43",

pages = "380--398",

journal = "Intensive Care Medicine",

issn = "0342-4642",

publisher = "Springer Verlag",

number = "3",

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Reintam Blaser, A, Starkopf, J, Alhazzani, W, Berger, MM, Casaer, MP, Deane, AM, Fruhwald, S, Hiesmayr, M, Ichai, C, Jakob, SM, Loudet, CI, Malbrain, MLNG, Montejo González, JC, Paugam-Burtz, C, Poeze, M, Preiser, JC, Singer, P, van Zanten, ARH, De Waele, J, Wendon, J, Wernerman, J, Whitehouse, T, Wilmer, A & Oudemans-van Straaten, HM 2017, 'Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines', Intensive Care Medicine, vol. 43, no. 3, pp. 380-398. https://doi.org/10.1007/s00134-016-4665-0

TY - JOUR

T1 - Early enteral nutrition in critically ill patients

T2 - ESICM clinical practice guidelines

AU - Reintam Blaser, Annika

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 - Montejo González, Juan C.

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 - 2017/3/1

Y1 - 2017/3/1

N2 - Purpose: To provide evidence-based guidelines for early enteral nutrition (EEN) during critical illness. Methods: 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. Results: 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. Conclusions: 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 - Purpose: To provide evidence-based guidelines for early enteral nutrition (EEN) during critical illness. Methods: 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. Results: 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. Conclusions: 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 - Contraindications

KW - Delay of enteral nutrition

KW - Early enteral nutrition

KW - GI symptoms

KW - Parenteral nutrition

UR - http://www.scopus.com/inward/record.url?scp=85011685227&partnerID=8YFLogxK

U2 - 10.1007/s00134-016-4665-0

DO - 10.1007/s00134-016-4665-0

M3 - Review article

AN - SCOPUS:85011685227

SN - 0342-4642

VL - 43

SP - 380

EP - 398

JO - Intensive Care Medicine

JF - Intensive Care Medicine

IS - 3

ER -

Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines

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Keywords

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