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Open Access 01-03-2017 | Conference Reports and Expert Panel

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

Authors: 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, ESICM Working Group on Gastrointestinal Function

Published in: Intensive Care Medicine | Issue 3/2017

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.

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Title: Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines
Authors: 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
ESICM Working Group on Gastrointestinal Function
Publication date: 01-03-2017
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 3/2017
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-016-4665-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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