Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Mar;43(3):380-398.
doi: 10.1007/s00134-016-4665-0. Epub 2017 Feb 6.

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

Annika Reintam Blaser  1   2 , Joel Starkopf  3   4 , Waleed Alhazzani  5   6 , Mette M Berger  7 , Michael P Casaer  8 , Adam M Deane  9 , Sonja Fruhwald  10 , Michael Hiesmayr  11 , Carole Ichai  12 , Stephan M Jakob  13 , Cecilia I Loudet  14 , Manu L N G Malbrain  15 , Juan C Montejo González  16 , Catherine Paugam-Burtz  17 , Martijn Poeze  18 , Jean-Charles Preiser  19 , Pierre Singer  20   21 , Arthur R H van Zanten  22 , Jan De Waele  23 , Julia Wendon  24 , Jan Wernerman  25 , Tony Whitehouse  26 , Alexander Wilmer  27 , Heleen M Oudemans-van Straaten  28 ; ESICM Working Group on Gastrointestinal Function
Affiliations
Review

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

Annika Reintam Blaser et al. Intensive Care Med. 2017 Mar.

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.

PubMed Disclaimer

Conflict of interest statement

See Supplement 8.

Figures

Fig. 1
Fig. 1
Forest plots (a mortality; b infections) Question 1A: early EN (EEN) vs. early PN (EPN) in unselected critically ill patients
Fig. 2
Fig. 2
Forest plots (a mortality; b infections) Question 1B: early EN (EEN) vs. delayed EN (DEN) in unselected critically ill patients
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Kreymann KG, Berger MM, Deutz NE, Hiesmayr M, Jolliet P, Kazandjiev G, Nitenberg G, van den Berghe G, Wernerman J, DGEM (German Society for Nutritional Medicine) Ebner C, Hartl W, Heymann C, Spies C, ESPEN (European Society for Parenteral and Enteral Nutrition) ESPEN guidelines on enteral nutrition: intensive care. Clin Nutr. 2006;25:210–223. doi: 10.1016/j.clnu.2006.01.021. - DOI - PubMed
    1. Fernández-Ortega JF, Herrero Meseguer JI, Martínez García P, Metabolism and Nutrition Working Group of the Spanish Society of Intensive Care Medicine and Coronary units Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: indications, timing and routes of nutrient delivery. Nutr Hosp. 2011;26(Suppl 2):7–11. - PubMed
    1. Taylor BE, McClave SA, Martindale RG, Warren MM, Johnson DR, Braunschweig C, McCarthy MS, Davanos E, Rice TW, Cresci GA, Gervasio JM, Sacks GS, Roberts PR, Compher C, Society of Critical Care Medicine; American Society of Parenteral and Enteral Nutrition Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Crit Care Med. 2016;44:390–438. doi: 10.1097/CCM.0000000000001525. - DOI - PubMed
    1. Casaer MP, Van den Berghe G. Nutrition in the acute phase of critical illness. N Engl J Med. 2014;370:1227–1236. doi: 10.1056/NEJMra1304623. - DOI - PubMed
    1. Weijs PJ, Looijaard WG, Beishuizen A, Girbes AR, Oudemans-van Straaten HM. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Crit Care. 2014;18:701. doi: 10.1186/s13054-014-0701-z. - DOI - PMC - PubMed