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Meta-Analysis
. 2024 Dec 24;17(1):10.
doi: 10.3390/nu17010010.

Comparison of Early Enteral Nutrition Versus Early Parenteral Nutrition in Critically Ill Patients: A Systematic Review and Meta-Analysis

Seung Min Baik  1 , Mina Kim  2 , Jae Gil Lee  1
Affiliations
Meta-Analysis

Comparison of Early Enteral Nutrition Versus Early Parenteral Nutrition in Critically Ill Patients: A Systematic Review and Meta-Analysis

Seung Min Baik et al. Nutrients. .

Abstract

Background: Nutritional support is crucial in critically ill patients to enhance recovery, reduce infections, and improve outcomes. This meta-analysis compared early enteral nutrition (EEN) and early parenteral nutrition (EPN) to evaluate their efficacy in adult critically ill patients.

Methods: A systematic review of 14 studies involving 7618 patients was conducted, including randomized controlled trials, prospective cohorts, and retrospective analyses. The primary outcomes were mortality and infectious complications, while secondary outcomes included intensive care unit length of stay (ICU-LOS), hospital length of stay (H-LOS), mechanical ventilation days, and gastrointestinal (GI) complications.

Results: The results showed no significant difference in mortality between EEN and EPN (OR 1.03, 95% CI 0.93-1.14). EEN reduced bloodstream infections (OR 0.73, 95% CI 0.57-0.93), ICU-LOS (MD -0.18 days, 95% CI -0.33 to -0.04), and H-LOS (MD -1.15 days, 95% CI -1.38 to -0.93). However, EEN was associated with higher GI complications, such as vomiting and diarrhea (OR 2.25, 95% CI 1.97-2.58), while mechanical ventilation days showed no significant difference.

Conclusions: These findings support prioritizing EEN in critically ill patients with functional gastrointestinal systems to improve infection control and recovery while emphasizing the importance of careful monitoring to mitigate gastrointestinal complications.

Keywords: critical illness; enteral nutrition; meta-analysis; nutritional support; parenteral nutrition.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of enrolled studies.
Figure 2
Figure 2
Assessment of risk of bias for RCTs using the Cochrane Risk of Bias (ROB) Tool. Green indicates low risk of bias, yellow indicates unclear risk, and red indicates high risk. Domains assessed include randomization, allocation concealment, blinding, incomplete outcome data, and selective reporting [7,8,11,12,15,18,21].
Figure 3
Figure 3
Assessment of risk of bias for non-RCTs using the ROBINS-2 Tool. Green indicates low risk, yellow indicates moderate risk, and red indicates serious or critical risk. Domains include confounding, selection of participants, classification of interventions, adherence to interventions, missing data, and measurement of outcomes [13,14,16,17,19,20,22].
Figure 4
Figure 4
(A). Forest plot for mortality comparing EEN vs. EPN. (B). Forest plot for new infection rates comparing EEN vs. EPN. (C). Forest plot for new blood stream infection or bacteria comparing EEN vs. EPN. (D). Forest plot for new pneumonia comparing EEN vs. EPN. (E). Forest plot for gastrointestinal complications comparing EEN vs. EPN. (F). Forest plot for the length of stay in the intensive care unit comparing EEN vs. EPN. (G). Forest plot for the length of stay in the hospital comparing EEN vs. EPN. (H). Forest plot for the days of mechanical ventilation comparing EEN vs. EPN. (EN, enteral nutrition; EEN, early enteral nutrition; PN, parenteral nutrition; EPN, early parenteral nutrition) [7,8,11,12,13,14,15,16,17,18,19,20,21,22].
Figure 4
Figure 4
(A). Forest plot for mortality comparing EEN vs. EPN. (B). Forest plot for new infection rates comparing EEN vs. EPN. (C). Forest plot for new blood stream infection or bacteria comparing EEN vs. EPN. (D). Forest plot for new pneumonia comparing EEN vs. EPN. (E). Forest plot for gastrointestinal complications comparing EEN vs. EPN. (F). Forest plot for the length of stay in the intensive care unit comparing EEN vs. EPN. (G). Forest plot for the length of stay in the hospital comparing EEN vs. EPN. (H). Forest plot for the days of mechanical ventilation comparing EEN vs. EPN. (EN, enteral nutrition; EEN, early enteral nutrition; PN, parenteral nutrition; EPN, early parenteral nutrition) [7,8,11,12,13,14,15,16,17,18,19,20,21,22].
Figure 4
Figure 4
(A). Forest plot for mortality comparing EEN vs. EPN. (B). Forest plot for new infection rates comparing EEN vs. EPN. (C). Forest plot for new blood stream infection or bacteria comparing EEN vs. EPN. (D). Forest plot for new pneumonia comparing EEN vs. EPN. (E). Forest plot for gastrointestinal complications comparing EEN vs. EPN. (F). Forest plot for the length of stay in the intensive care unit comparing EEN vs. EPN. (G). Forest plot for the length of stay in the hospital comparing EEN vs. EPN. (H). Forest plot for the days of mechanical ventilation comparing EEN vs. EPN. (EN, enteral nutrition; EEN, early enteral nutrition; PN, parenteral nutrition; EPN, early parenteral nutrition) [7,8,11,12,13,14,15,16,17,18,19,20,21,22].
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