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Meta-Analysis
. 2006 Jul 19;2006(3):CD005489.
doi: 10.1002/14651858.CD005489.pub2.

Early versus delayed enteral nutrition support for burn injuries

J Wasiak  1 , H Cleland, R Jeffery
Affiliations
Meta-Analysis

Early versus delayed enteral nutrition support for burn injuries

J Wasiak et al. Cochrane Database Syst Rev. .

Abstract

Background: A burn injury increases the body's metabolic demands, and therefore nutritional requirements. Provision of an adequate supply of nutrients is believed to lower the incidence of metabolic abnormalities, thus reducing septic morbidity, improving survival rates, and decreasing hospital length of stay. Enteral nutrition support is the best feeding method for patients who are unable to achieve an adequate oral intake to maintain gastrointestinal functioning, however, its timing (i.e. early versus late) needs to be established.

Objectives: To assess the effectiveness and safety of early versus late enteral nutrition support in adults with burn injury.

Search strategy: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, issue 1, 2006), the Cochrane Injuries Group's Specialised Register, MEDLINE (1966 to May week 1, 2006), EMBASE (1980 to week 17, 2005) and CINAHL (1982 to May week 1, 2006).

Selection criteria: We included all randomised controlled trials comparing early enteral nutrition support (within 24 hours of injury) versus delayed enteral support (greater than 24 hours).

Data collection and analysis: Two authors used standardised forms to independently extract the data. Each trial was assessed for internal validity with differences resolved by discussion.

Main results: A total of three randomised controlled trials were eligible for inclusion in this review. Results of the studies indicate that evidence about the benefit of early enteral nutritional support on standardised clinical outcomes such as length of hospital stay and mortality, remains inconclusive. Similarly, the question of whether early enteral feeding influenced or decreased metabolic rate as documented in part by our included studies, remains uncertain.

Authors' conclusions: This systematic review has not found sufficient evidence to support or refute the effectiveness of early versus late enteral nutrition support in adults with burn injury. The trials showed some promising results that would suggest early enteral nutrition support may blunt the hypermetabolic response to thermal injury, but this is insufficient to provide clear guidelines for practice. Further research incorporating larger sample sizes and rigorous methodology that utilises valid and reliable outcome measures, is essential.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Death, Outcome 1 All cause mortality at end of follow‐up.
2.1
2.1. Analysis
Comparison 2 Overall length of stay, Outcome 1 Length of acute stay days.
2.2
2.2. Analysis
Comparison 2 Overall length of stay, Outcome 2 Number of ICU days.
3.1
3.1. Analysis
Comparison 3 Frequency of infection, Outcome 1 Number of infections.
3.2
3.2. Analysis
Comparison 3 Frequency of infection, Outcome 2 Number of antibiotic days.
4.1
4.1. Analysis
Comparison 4 Adverse events, Outcome 1 Aspiration events.
4.2
4.2. Analysis
Comparison 4 Adverse events, Outcome 2 Commencement of TPN.
4.3
4.3. Analysis
Comparison 4 Adverse events, Outcome 3 Unplanned days without feeds.
4.4
4.4. Analysis
Comparison 4 Adverse events, Outcome 4 Perctange (%) of days with diarrhoea.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Peck 2004 {published data only}
    1. Peck MD, Kessler M, Cairns BA, Chang YH, Ivanova A, Schooler W. Early enteral nutrition does not decrease hypermetabolism associated with burn injury. Journal of Trauma 2004;57(6):1143‐9. - PubMed
Peng 2001 {published data only}
    1. Peng YZ, Yuan ZQ, Xiao GX. Effects of early enteral feeding on the prevention of enterogenic infection in severely burned patients. Burns 2001;27(2):145‐9. - PubMed
Wang 1997 {published data only}
    1. Wang S, Wang S, Li A. A clinical study of early enteral feeding to protect gut function in burned patients. Chinese Journal of Plastic Surgery 1997;13(4):267‐71. - PubMed
    1. Wang S, Wang S, You Z. Clinical study of the effect of early enteral feeding on reducing hypermetabolism after server burns. Chinese Journal of Surgery 1996;35(1):44‐7. - PubMed

References to studies excluded from this review

Andel 2001 {published data only}
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Chen 2006 {published data only}
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Engelhardt 1994 {published data only}
    1. Engelhardt VJ, Clark SM. Early enteral feeding of a severely burned pediatric patient. Journal of Burn Care and Rehabilitation 1994;12:293‐7. - PubMed
Enzi 1990 {published data only}
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Garrel 1991 {published data only}
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Gottschlich 2002 {published data only}
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Hansbrough 1993 {published data only}
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Hart 2003 {published data only}
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Kaufman 1986 {published data only}
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Koller 1994 {published data only}
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McArdle 1984 {published data only}
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McDonald 1991 {published data only}
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Noordenbos 2000 {published data only}
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Taylor 1999 {published data only}
    1. Taylor SJ. Early enhanced enteral nutrition in burned patient is associated with fewer infective complications and shorter hospital stay. J Human Nutrition and Dietetics 1999;12:85‐91.

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