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. 2023 Jul 19;15(14):3201.
doi: 10.3390/nu15143201.

The Effectiveness of Early Enteral Nutrition on Clinical Outcomes in Critically Ill Sepsis Patients: A Systematic Review

Sun Jae Moon  1 , Ryoung-Eun Ko  2 , Chi-Min Park  2   3 , Gee Young Suh  2   4 , Jinseub Hwang  5 , Chi Ryang Chung  1   2
Affiliations

The Effectiveness of Early Enteral Nutrition on Clinical Outcomes in Critically Ill Sepsis Patients: A Systematic Review

Sun Jae Moon et al. Nutrients. .

Abstract

The optimal timing of enteral nutrition (EN) in sepsis patients is controversial among societal guidelines. We aimed to evaluate the evidence of early EN's impact on critically ill sepsis patients' clinical outcomes. We searched the MEDLINE, Embase, CINAHL, Cochrane Library, ClinicalTrials.gov, and ICTRP databases on 10 March 2023. We included studies published after 2004 that compared early EN versus delayed EN in sepsis patients. We included randomized controlled trials (RCTs), non-RCTs, cohort studies, and case-control studies. Forest plots were used to summarize risk ratios (RRs), including mortality and mean difference (MD) of continuous variables such as intensive care unit (ICU) length of stay and ventilator-free days. We identified 11 eligible studies with sample sizes ranging from 31 to 2410. The RR of short-term mortality from three RCTs was insignificant, and the MD of ICU length of stay from two RCTs was -2.91 and -1.00 days (95% confidence interval [CI], -5.53 to -0.29 and -1.68 to -0.32). Although the RR of intestinal-related complications from one RCT was 3.82 (95% CI, 1.43 to 10.19), indicating a significantly higher risk for the early EN group than the control group, intestinal-related complications of EN reported in five studies were inconclusive. This systematic review did not find significant benefits of early EN on mortality in sepsis patients. Evidence, however, is weak due to inconsistent definitions, heterogeneity, risk of bias, and poor methodology in the existing studies.

Keywords: enteral nutrition; intensive care unit; sepsis; septic shock; systematic review.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the systematic review process.
Figure 2
Figure 2
Forest plot of clinical outcomes (a) mortality; (b) length of stay in intensive care unit; (c) ventilator-free days. CI, confidence interval; DEN, delayed enteral nutrition; EEN, early enteral nutrition; ICU, intensive care unit; SD standard deviation. The blue bars in the figure indicate the results of the risk ratio and the green bars indicate the results of the mean difference [29,30,32].
See this image and copyright information in PMC

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