TITLE

Does Enteral Nutrition Affect Clinical Outcome? A Systematic Review of the Randomized Trials

AUTHOR(S)
Koretz, Ronald L.; Avenell, Alison; Lipman, Timothy O.; Braunschweig, Carol L.; Milne, Anne C.
PUB. DATE
February 2007
SOURCE
American Journal of Gastroenterology;Feb2007, Vol. 102 Issue 2, p412
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
BACKGROUND: Both parenteral nutrition (PN) and enteral nutrition (EN) are widely advocated as adjunctive care in patients with various diseases. A systematic review of 82 randomized controlled trials (RCTs) of PN published in 2001 found little, if any, effect on mortality, morbidity, or duration of hospital stay; in some situations, PN increased infectious complication rates. OBJECTIVE: The objective was to assess the effect of EN or volitional nutrition support (VNS) in individual disease states from available RCTs. DESIGN: We conducted a systematic review. RCTs comparing EN or VNS with untreated controls, or comparing EN with PN, were identified and separated according to the underlying disease state. Meta-analysis was performed when at least three RCTs provided data. The evidence from the RCTs was summarized into one of five grades. A or B, respectively, indicated the presence of strong or weak (low-quality RCTs) evidence supporting the use of the intervention. C indicated a lack of adequate evidence to make any decision about efficacy. D indicated that limited data could not support the intervention. E indicated either that strong data found no effect, or that either strong or weak data suggested that the intervention caused harm. PATIENTS AND SETTINGS: RCTs could include either hospitalized or nonhospitalized patients. The EN or VNS had to be provided as part of a treatment plan for an underlying disease process. INTERVENTIONS: The RCT had to compare recipients of either EN or VNS with controls not receiving any type of artificial nutrition or had to compare recipients of EN with recipients of PN. OUTCOME MEASURES: These were mortality, morbidity (disease specific), duration of hospitalization, cost, or interventional complications. SUMMARY OF GRADING: A: No indication was identified. B: EN or VNS in the perioperative patient or in patients with chronic liver disease; EN in critically ill patients or low birth weight infants (trophic feeding); VNS in malnourished geriatric patients. (The low-quality trials found a significant difference in survival favoring the VNS recipients in the malnourished geriatric patient trials; two high-quality trials found nonsignificant differences that favored VNS as well.) C: EN or VNS in liver transplantation, cystic fibrosis, renal failure, pediatric conditions other than low birth weight infants, well-nourished geriatric patients, nonstroke neurologic conditions, AIDS; EN in acute pancreatitis, chronic obstructive pulmonary disease, nonmalnourished geriatric patients; VNS in inflammatory bowel disease, arthritis, cardiac disease, pregnancy, allergic patients, preoperative bowel preparation. D: EN or VNS in patients receiving nonsurgical cancer treatment or in patients with hip fractures; EN in patients with inflammatory bowel disease; VNS in patients with chronic obstructive pulmonary disease. E: EN in the first week in dysphagic, or VNS at any time in nondysphagic, stroke patients who are not malnourished; dysphagia persisting for weeks will presumably ultimately require EN. CONCLUSIONS: There is strong evidence for not using EN in the first week in dysphagic, and not using VNS at all in nondysphagic, stroke patients who are not malnourished. There is reasonable evidence for using VNS in malnourished geriatric patients. The recommendations to consider EN/VNS in perioperative/liver/critically ill/low birth weight patients are limited by the low quality of the RCTs. No evidence could be identified to justify the use of EN/VNS in other disease states.
ACCESSION #
23774320

 

Related Articles

  • Bedside TPN: The Practicing Surgeon. Phillips, B. J // Internet Journal of Pharmacology;2002, Vol. 1 Issue 1, p56 

    We present an easy way to calculate the requirements and components of a total parenteral nutrition TPN.

  • Evaluación de la actividad asistencial de un equipo multidisciplinario de soporte nutricional en el seguimiento de la nutrición parenteral total. Olmos, M. A. Martínez; Vázquez, M. J. Martínez; Hernández, M. Montero; Homar, P. Siquier; Beneitez, J. Valdueza; Gorría1, M. J. Morales; Fernández-Vega, M. J. Arbones; González, E. Pena; Bobo, M. T. Inaraja // Nutricion Hospitalaria;2006, Vol. 21 Issue 1, p57 

    Introduction: In total parenteral nutrition (TPN) nutritional support multidisciplinary teams (NSMT) must provide a high quality nutritional assistance based on evidence and daily follow-up of patients with TPN. Objectives: To assess the degree of adherence to quality standards of care provided...

  • Assessment of implementation of a standardized parenteral formulation for early nutritional support of very preterm infants. Lenclen, Richard; Crauste-Manciet, Sylvie; Narcy, Philippe; Boukhouna, Saida; Geffray, Amélie; Guerrault, Marie-Noëlle; Bordet, François; Brossard, Denis // European Journal of Pediatrics;Aug2006, Vol. 165 Issue 8, p512 

    Presents a study which assessed the role of parenteral nutrition (PN) in the nutritional support of very preterm newborns. Relevance of the implemented standardized PN regime; Common method for PN preparation; Local prescribing guidelines for neonatal nutrition.

  • Metabolic complications of parenteral nutrition in adults, part 2. Btaiche, Imad F.; Khalidi, Nabil // American Journal of Health-System Pharmacy;10/1/2004, Vol. 61 Issue 19, p2050 

    Part II. Studies common metabolic complications associated with parenteral nutrition (PN) and the consequences of overfeeding and variables for patient monitoring. Complications associated with the use of PN; Patient and PN-specific factors that determine the frequency and severity of...

  • Parenteral nutrition. Ghosh, Deb; Neild, Penny // Clinical Medicine;Dec2010, Vol. 10 Issue 6, p620 

    The article offers clinical information on parenteral nutrition (PN), the intravenous (IV) delivery of artificial and nutritionally balanced combination of sterile nutrients. PN is clinically indicated for patients who underwent extensive small bowel resection, those who have peritonitis from a...

  • Online IV Nutrition Calculator Reduces Medical Errors, Saves Time.  // Ascribe Newswire: Medicine;4/16/2004, p4 

    Researchers at the Johns Hopkins Children's Center have designed an online, Web-based system for ordering total parenteral nutrition (TPN) that identifies and pre-emptively eliminates potentially serious calculation errors. The Children's Center team describes its TPN Calculator in the April...

  • Impacto de la introducción de un programa de nutrición parenteral por la unidad de nutrición clínica en pacientes quirürgicos. Gálvez, E. Heredero; Romero, F. Botella; García, M. Lizán; Cabrera, R. Herruzo // Nutricion Hospitalaria;ene/feb2009, Vol. 24 Issue 1, p68 

    Introduction: The creation of a Nutrition Unit (NU), with a specialized professional establishing homogenous criteria and standardized proceedings for the use of parenteral nutrition (PN) may improve the clinical course of the patients and decrease the number of technique-related complications....

  • Enteral and parenteral nutrition distinctively modulate intestinal permeability and T cell function in vitro. Guzy, Claudia; Schirbel, Anja; Paclik, Daniela; Wiedenmann, Bertram; Dignass, Axel; Sturm, Andreas // European Journal of Nutrition;Feb2009, Vol. 48 Issue 1, p12 

    Nutritional support is an established element of therapy for various indications. However, its impact on the mucosal barrier function is not well understood. We investigated the influence of EN and PN on intestinal epithelial cells and peripheral blood (PBMC) and lamina propria mononuclear cells...

  • LONG TERM PARENTERAL NUTRITION BY MEANS OF AN ARTERIO-VENOUS (A-V) FISTULA. Jamieson, Alastair; Dirnfeld, Victor // Vascular Surgery;Nov/Dec1972, Vol. 6 Issue 5, p251 

    The use of prolonged parenteral nutrition by hyperalimentation technique is described. To reduce the risk of septicemia, frequently fungal and often fatal, and to allow easy frequent changing of the intravenous site, an A-V fistula was created in the forearm. This has functioned without any...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics