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Meta-Analysis
. 2024 May 22;16(11):1560.
doi: 10.3390/nu16111560.

Early Enteral Nutrition (within 48 h) for Patients with Sepsis or Septic Shock: A Systematic Review and Meta-Analysis

Carlos F Grillo-Ardila  1   2   3 , Diego Tibavizco-Palacios  1   3 , Luis C Triana  1   3 , Saúl J Rugeles  4 , María T Vallejo-Ortega  5 , Carlos H Calderón-Franco  6 , Juan J Ramírez-Mosquera  7
Affiliations
Meta-Analysis

Early Enteral Nutrition (within 48 h) for Patients with Sepsis or Septic Shock: A Systematic Review and Meta-Analysis

Carlos F Grillo-Ardila et al. Nutrients. .

Abstract

Objective: Medical nutrition therapy provides the opportunity to compensate for muscle wasting and immune response activation during stress and trauma. The objective of this systematic review is to assess the safety and effectiveness of early enteral nutrition (EEN) in adults with sepsis or septic shock.

Methods: The MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, and ICTRP tools were searched from inception until July 2023. Conference proceedings, the reference lists of included studies, and expert content were queried to identify additional publications. Two review authors completed the study selection, data extraction, and risk of bias assessment; disagreements were resolved through discussion. Inclusion criteria were randomized controlled trials (RCTs) and non-randomized studies (NRSs) comparing the administration of EEN with no or delayed enteral nutrition (DEE) in adult populations with sepsis or septic shock.

Results: Five RCTs (n = 442 participants) and ten NRSs (n = 3724 participants) were included. Low-certainty evidence from RCTs and NRSs suggests that patients receiving EEN could require fewer days of mechanical ventilation (MD -2.65; 95% CI, -4.44-0.86; and MD -2.94; 95% CI, -3.64--2.23, respectively) and may show lower SOFA scores during follow-up (MD -1.64 points; 95% CI, -2.60--0.68; and MD -1.08 points; 95% CI, -1.90--0.26, respectively), albeit with an increased frequency of diarrhea episodes (OR 2.23, 95% CI 1.115-4.34). Even though the patients with EEN show a lower in-hospital mortality rate both in RCTs (OR 0.69; 95% CI, 0.39-1.23) and NRSs (OR 0.89; 95% CI, 0.69-1.13), this difference does not achieve statistical significance. There were no apparent differences for other outcomes.

Conclusions: Low-quality evidence suggests that EEN may be a safe and effective intervention for the management of critically ill patients with sepsis or septic shock.

Keywords: critical care; enteral nutrition; sepsis; systematic review.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study flow diagram. Inclusion of studies at different stages for this systematic review and meta-analysis.
Figure 2
Figure 2
Funnel plot for EEN versus DEN. Outcome: in-hospital mortality [26,27,28,29,31,33,35,36,37,38].
Figure 3
Figure 3
Funnel plot for EEN versus DEN. Outcome: mechanical ventilation [30,31,34,35,36,37].
Figure 4
Figure 4
Funnel plot for EEN versus DEN. Outcome: SOFA score [30,33,39].
Figure 5
Figure 5
Funnel plot for EEN versus DEN. Outcome: renal replacement therapy [26,29,30,40].
Figure 6
Figure 6
Funnel plot for EEN versus DEN. Outcome: diarrhea [26,28].
See this image and copyright information in PMC

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