Comparing Effects of Enteral and Parenteral Nutrition in Patients Admitted to Intensive Care Units: A Systematic Review
Abstract
Background: With regard to critical illness and stress, medication side effects, decreased appetite, and increased nausea and vomiting; patients admitted to intensive care units (ICUs) are at particular risk of malnutrition. Feeding behavior i.e. time and method in these patients has still remained as an unresolved issue. Thus; enteral and parenteral nutrition, with their own benefits and complications, are two commonly used methods for such individuals. The present systematic review was to compare the effects of enteral and parenteral nutrition in patients admitted to ICUs.
Methods: This systematic review investigated a total number of 1642 articles on nutrition methods in ICU patients during 2010-2019 using keywords of “enteral nutrition, parenteral nutrition solutions, parenteral nutrition, critical care outcomes, critical illness, intensive care unit, and ICU” in the databases of SID, Iranmedex, MEDLIB-ED, PubMed, Scopus, Medline, Embase, Cochrane, Web of Science, and Google Scholar; and finally, 15 articles were analyzed in relation to the research objectives.
Results: Studies indicated that patient mortality was not different in enteral and parenteral nutrition groups. The incidence rate of infectious complications was also reported higher in parenteral nutrition group. However, there was no significant difference in the incidence rate of infections in studies meeting total standards for parenteral nutrition. Besides, there was no significant difference between the duration of undergoing mechanical ventilation and hospitalization time in both groups. Furthermore, the incidence rate of hypoglycemia was higher in enteral nutrition group; but serum protein levels had much better status compared with those in parenteral nutrition group.
Conclusion: If standards for infusion are observed and provided that rates of infectious complications are reduced, patients can benefit from starting parenteral nutrition immediately after admission to ICUs in the absence of enteral method.
[1] Peter JV, Moran JL, Phillips-Hughes J. A metaanalysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients. Crit Care Med. 2005; 33(1):213-20.
[2] Doig GS, Simpson F, Sweetman EA, Finfer SR, Cooper DJ, Heighes PT, et al. Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: a randomized controlled trial. Jama. 2013; 309(20):2130-8.
[3] Reignier J, Darmon M, Sonneville R, Borel A-L, Garrouste-Orgeas M, Ruckly S, et al. Impact of early nutrition and feeding route on outcomes of mechanically ventilated patients with shock: a post hoc marginal structural model study. Intensive Care Med. 2015; 41(5):875-86.
[4] Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr. 2003; 27(5):355-73.
[5] Kreymann K, Berger M, Deutz Ne, Hiesmayr M, Jolliet P, Kazandjiev G, et al. ESPEN guidelines on enteral nutrition: intensive care. Clin Nutr. 2006; 25(2):210-23.
[6] Tadayonfar M, Tajabadi A, Kooshki A. Evaluation of macro and micro nutrients intake in ICU patients. 2017; 24(1):29-33.
[7] Singer P, Pichard C, Heidegger CP, Wernerman J. Considering energy deficit in the intensive care unit. Curr Opin Clin Nutr Metab Care. 2010; 13(2):170-6.
[8] Barrett M, Demehri FR, Teitelbaum DH. Intestine, immunity and parenteral nutrition in an era of preferred enteral feeding. Curr Opin Clin Nutr Metab Care. 2015; 18(5):496-500.
[9] McClave SA, Heyland DK. The physiologic response and associated clinical benefits from provision of early enteral nutrition. Nutr Clin Pract. 2009; 24(3):305-15.
[10] Cahill NE, Dhaliwal R, Day AG, Jiang X, Heyland DK. Nutrition therapy in the critical care setting: what is “best achievable” practice? An international multicenter observational study. Crit Care Med. 2010; 38 (2): 395-401.
[11] Kudsk KA. Importance of enteral feeding in maintaining gut integrity. Techniques in Gastrointestinal Endoscopy. 2001; 3(1):2-8.
[12] Dobbins WO 3rd. Gut immunophysiology: a gastroenterologist's view with emphasis on pathophysiology. Am J Physiol. 1982; 242(1): G1-G8.
[13] Alverdy J, Zaborina O, Wu L. The impact of stress and nutrition on bacterial-host interactions at the intestinal epithelial surface. Curr Opin Clin Nutr Metab Care. 2005; 8 (2): 205-9.
[14] Dhaliwal R, Cahill N, Lemieux M, Heyland DK. The Canadian critical care nutrition guidelines in 2013: an update on current recommendations and implementation strategies. Nutr Clin Pract. 2014; 29(1):29-43.
[15] Braunschweig CL, Levy P, Sheean PM, Wang X. Enteral compared with parenteral nutrition: a meta-analysis. Am J Clin Nutr. 2001; 74(4):534-42.
[16] Gramlich L, Kichian K, Pinilla J, Rodych NJ, Dhaliwal R, Heyland DK. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition. 2004; 20(10):843-8.
[17] Heyland DK, Konopad E, Alberda C, Keefe L, Cooper C, Cantwell B. How well do critically ill patients tolerate early, intragastric enteral feeding? Results of a prospective, multicenter trial. Nutrition in clinical practice. 1999;14(1):23-8.
[18] Rello J, Quintana E, Ausina V, Castella J, Luquin M, Net A, et al. Incidence, etiology, and outcome of nosocomial pneumonia in mechanically ventilated patients. Chest. 1991;100(2):439-44.
[19] Kudsk KA, Croce MA, Fabian TC, Minard G, Tolley EA, Poret HA, et al. Enteral versus parenteral feeding. Effects on septic morbidity after blunt and penetrating abdominal trauma. Ann Surg. 1992; 215(5):503.
[20] Oshima T, Hiesmayr M, Pichard C. Parenteral nutrition in the ICU setting: need for a shift in utilization. Curr Opin Clin Nutr Metab Care. 2016; 19(2):144-50.
[21] Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365(6): 506-17.
[22] Harvey SE, Parrott F, Harrison DA, Bear DE, Segaran E, Beale R, et al. Trial of the route of early nutritional support in critically ill adults. N Engl J Med. 2014; 371(18):1673-84
[23] Altintas ND, Aydin K, Türkoğlu MA, Abbasoğlu O, Topeli A. Effect of enteral versus parenteral nutrition on outcome of medical patients requiring mechanical ventilation. Nutr Clin Pract. 2011; 26(3):322-9.
[24] Tao Y, Tang C, Feng W, Bao Y, Yu H. Early nasogastric feeding versus parenteral nutrition in severe acute pancreatitis: A retrospective study. Pak J Med Sci. 2016; 32(6):1517.
[25] Doig GS, Simpson F, Sweetman EA, Finfer SR, Cooper DJ, Heighes PT, et al. Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: a randomized controlled trial. Jama. 2013; 309(20):2130-8.
[26] Fan M-c, Wang Q-l, Fang W, Jiang Y-x, Sun P, Wang Z-h. Early enteral combined with parenteral nutrition treatment for severe traumatic brain injury: effects on immune function, nutritional status and outcomes. Chin Med Sci J. 2016; 31(4):213-20.
[27] Allingstrup MJ, Kondrup J, Wiis J, Claudius C, Pedersen UG, Hein-Rasmussen R, et al. Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial. Intensive Care Med. 2017; 43(11):1637-47.
[28] Reignier J, Boisramé-Helms J, Brisard L, Lascarrou J-B, Hssain AA, Anguel N, et al. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet. 2018; 391(10116):133-43.
[29] Gavri C, Kokkoris S, Vasileiadis I, Oeconomopoulou AC, Kotanidou A, Nanas S, et al. Route of nutrition and risk of blood stream infections in critically ill patients; a comparative study. Clin Nutr ESPEN. 2016; 12:e14-e9.
[30] Aaben C, Hammarqvist F, Mabesa T, Hardcastle T. Complications relating to enteral and parenteral nutrition in trauma patients: a retrospective study at a level one trauma centre in South Africa. South African Journal of Clinical Nutrition. 2015; 28(2):62-8.
[31] Matsushima K, Cook A, Tyner T, Tollack L, Williams R, Lemaire S, et al. Parenteral nutrition: a clear and present danger unabated by tight glucose control. Am J Surg. 2010; 200(3):386-90.
[32] Cahill NE, Murch L, Jeejeebhoy K, McClave SA, Day AG, Wang M, et al. When early enteral feeding is not possible in critically ill patients: results of a multicenter observational study. JPEN J Parenter Enteral Nutr. 2011; 35(2):160-8.
[33] Dissanaike S, Shelton M, Warner K, O'Keefe GE. The risk for bloodstream infections is associated with increased parenteral caloric intake in patients receiving parenteral nutrition. Crit Care. 2007; 11(5):R114.
[34] Yang H, Feng Y, Sun X, Teitelbaum DH. Enteral versus parenteral nutrition: effect on intestinal barrier function. Ann N Y Acad Sci. 2009; 1165(1):338-46.
[35] Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001; 345(19):1359-67.
[36] Vlasselaers D, Milants I, Desmet L, Wouters PJ, Vanhorebeek I, van den Heuvel I, et al. Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study. Lancet. 2009; 373(9663):547-56.
[37] Pacelli F, Bossola M, Papa V, Malerba M, Modesti C, Sgadari A, et al. Enteral vs parenteral nutrition after major abdominal surgery: an even match. Archives of surgery. 2001;136(8):933-6.
[38] De Jonghe B, Appere-De-Vechi C, Fournier M, Tran B, Merrer J, Melchior J-C, et al. A prospective survey of nutritional support practices in intensive care unit patients: what is prescribed? What is delivered? Critical care medicine. 2001; 29(1):8-12.
[39] Klek S, Sierzega M, Szybinski P, Szczepanek K, Scislo L, Walewska E, et al. Perioperative nutrition in malnourished surgical cancer patients–a prospective, randomized, controlled clinical trial. Clinical nutrition. 2011;30(6):708-13.
[40] Pontes-Arruda A, Zaloga G, Wischmeyer P, Turpin R, Liu FX, Mercaldi C. Is there a difference in bloodstream infections in critically ill patients associated with ready-to-use versus compounded parenteral nutrition? Clinical nutrition. 2012;31(5):728-34.
[41] Turpin R, Solem C, Pontes-Arruda A, Sanon M, Mehta S, Liu FX, et al. The impact of parenteral nutrition preparation on bloodstream infection risk and costs. European journal of clinical nutrition. 2014;68(8):953.
[42] Nachvak M, Hedayati S, Hejazi N, Motamedi Motlagh A, Shafizade A, Shojaee M. Nutritional assessment in ICU patients with enteral feeding in Amol hospitals. Razi Journal of Medical Sciences. 2018;24(10):92-104.
[43] Shayesteh F, Poudineh S, Pouryazdanpanah-Kermani M, Sadat Ayoudi S, Norouzy A. Assessment of nutritional intake in intensive care unit patients of Ghaem hospital. medical journal of mashhad university of medical sciences. 2015;58(4):217-24.
[44] Braunschweig CL, Levy P, Sheean PM, Wang X. Enteral compared with parenteral nutrition: a meta-analysis. The American journal of clinical nutrition. 2001;74(4):534-42
[45] Simpson F, Doig GS. Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle. Intensive care medicine. 2005;31(1):12-23.
[46] Elke G, van Zanten AR, Lemieux M, McCall M, Jeejeebhoy KN, Kott M, et al. Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Critical Care. 2016;20(1):117.
[47] Shi J, Wei L, Huang R, Liao L. Effect of combined parenteral and enteral nutrition versus enteral nutrition alone for critically ill patients: a systematic review and meta-analysis. Medicine. 2018; 97(41).
[2] Doig GS, Simpson F, Sweetman EA, Finfer SR, Cooper DJ, Heighes PT, et al. Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: a randomized controlled trial. Jama. 2013; 309(20):2130-8.
[3] Reignier J, Darmon M, Sonneville R, Borel A-L, Garrouste-Orgeas M, Ruckly S, et al. Impact of early nutrition and feeding route on outcomes of mechanically ventilated patients with shock: a post hoc marginal structural model study. Intensive Care Med. 2015; 41(5):875-86.
[4] Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr. 2003; 27(5):355-73.
[5] Kreymann K, Berger M, Deutz Ne, Hiesmayr M, Jolliet P, Kazandjiev G, et al. ESPEN guidelines on enteral nutrition: intensive care. Clin Nutr. 2006; 25(2):210-23.
[6] Tadayonfar M, Tajabadi A, Kooshki A. Evaluation of macro and micro nutrients intake in ICU patients. 2017; 24(1):29-33.
[7] Singer P, Pichard C, Heidegger CP, Wernerman J. Considering energy deficit in the intensive care unit. Curr Opin Clin Nutr Metab Care. 2010; 13(2):170-6.
[8] Barrett M, Demehri FR, Teitelbaum DH. Intestine, immunity and parenteral nutrition in an era of preferred enteral feeding. Curr Opin Clin Nutr Metab Care. 2015; 18(5):496-500.
[9] McClave SA, Heyland DK. The physiologic response and associated clinical benefits from provision of early enteral nutrition. Nutr Clin Pract. 2009; 24(3):305-15.
[10] Cahill NE, Dhaliwal R, Day AG, Jiang X, Heyland DK. Nutrition therapy in the critical care setting: what is “best achievable” practice? An international multicenter observational study. Crit Care Med. 2010; 38 (2): 395-401.
[11] Kudsk KA. Importance of enteral feeding in maintaining gut integrity. Techniques in Gastrointestinal Endoscopy. 2001; 3(1):2-8.
[12] Dobbins WO 3rd. Gut immunophysiology: a gastroenterologist's view with emphasis on pathophysiology. Am J Physiol. 1982; 242(1): G1-G8.
[13] Alverdy J, Zaborina O, Wu L. The impact of stress and nutrition on bacterial-host interactions at the intestinal epithelial surface. Curr Opin Clin Nutr Metab Care. 2005; 8 (2): 205-9.
[14] Dhaliwal R, Cahill N, Lemieux M, Heyland DK. The Canadian critical care nutrition guidelines in 2013: an update on current recommendations and implementation strategies. Nutr Clin Pract. 2014; 29(1):29-43.
[15] Braunschweig CL, Levy P, Sheean PM, Wang X. Enteral compared with parenteral nutrition: a meta-analysis. Am J Clin Nutr. 2001; 74(4):534-42.
[16] Gramlich L, Kichian K, Pinilla J, Rodych NJ, Dhaliwal R, Heyland DK. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition. 2004; 20(10):843-8.
[17] Heyland DK, Konopad E, Alberda C, Keefe L, Cooper C, Cantwell B. How well do critically ill patients tolerate early, intragastric enteral feeding? Results of a prospective, multicenter trial. Nutrition in clinical practice. 1999;14(1):23-8.
[18] Rello J, Quintana E, Ausina V, Castella J, Luquin M, Net A, et al. Incidence, etiology, and outcome of nosocomial pneumonia in mechanically ventilated patients. Chest. 1991;100(2):439-44.
[19] Kudsk KA, Croce MA, Fabian TC, Minard G, Tolley EA, Poret HA, et al. Enteral versus parenteral feeding. Effects on septic morbidity after blunt and penetrating abdominal trauma. Ann Surg. 1992; 215(5):503.
[20] Oshima T, Hiesmayr M, Pichard C. Parenteral nutrition in the ICU setting: need for a shift in utilization. Curr Opin Clin Nutr Metab Care. 2016; 19(2):144-50.
[21] Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365(6): 506-17.
[22] Harvey SE, Parrott F, Harrison DA, Bear DE, Segaran E, Beale R, et al. Trial of the route of early nutritional support in critically ill adults. N Engl J Med. 2014; 371(18):1673-84
[23] Altintas ND, Aydin K, Türkoğlu MA, Abbasoğlu O, Topeli A. Effect of enteral versus parenteral nutrition on outcome of medical patients requiring mechanical ventilation. Nutr Clin Pract. 2011; 26(3):322-9.
[24] Tao Y, Tang C, Feng W, Bao Y, Yu H. Early nasogastric feeding versus parenteral nutrition in severe acute pancreatitis: A retrospective study. Pak J Med Sci. 2016; 32(6):1517.
[25] Doig GS, Simpson F, Sweetman EA, Finfer SR, Cooper DJ, Heighes PT, et al. Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: a randomized controlled trial. Jama. 2013; 309(20):2130-8.
[26] Fan M-c, Wang Q-l, Fang W, Jiang Y-x, Sun P, Wang Z-h. Early enteral combined with parenteral nutrition treatment for severe traumatic brain injury: effects on immune function, nutritional status and outcomes. Chin Med Sci J. 2016; 31(4):213-20.
[27] Allingstrup MJ, Kondrup J, Wiis J, Claudius C, Pedersen UG, Hein-Rasmussen R, et al. Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial. Intensive Care Med. 2017; 43(11):1637-47.
[28] Reignier J, Boisramé-Helms J, Brisard L, Lascarrou J-B, Hssain AA, Anguel N, et al. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet. 2018; 391(10116):133-43.
[29] Gavri C, Kokkoris S, Vasileiadis I, Oeconomopoulou AC, Kotanidou A, Nanas S, et al. Route of nutrition and risk of blood stream infections in critically ill patients; a comparative study. Clin Nutr ESPEN. 2016; 12:e14-e9.
[30] Aaben C, Hammarqvist F, Mabesa T, Hardcastle T. Complications relating to enteral and parenteral nutrition in trauma patients: a retrospective study at a level one trauma centre in South Africa. South African Journal of Clinical Nutrition. 2015; 28(2):62-8.
[31] Matsushima K, Cook A, Tyner T, Tollack L, Williams R, Lemaire S, et al. Parenteral nutrition: a clear and present danger unabated by tight glucose control. Am J Surg. 2010; 200(3):386-90.
[32] Cahill NE, Murch L, Jeejeebhoy K, McClave SA, Day AG, Wang M, et al. When early enteral feeding is not possible in critically ill patients: results of a multicenter observational study. JPEN J Parenter Enteral Nutr. 2011; 35(2):160-8.
[33] Dissanaike S, Shelton M, Warner K, O'Keefe GE. The risk for bloodstream infections is associated with increased parenteral caloric intake in patients receiving parenteral nutrition. Crit Care. 2007; 11(5):R114.
[34] Yang H, Feng Y, Sun X, Teitelbaum DH. Enteral versus parenteral nutrition: effect on intestinal barrier function. Ann N Y Acad Sci. 2009; 1165(1):338-46.
[35] Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001; 345(19):1359-67.
[36] Vlasselaers D, Milants I, Desmet L, Wouters PJ, Vanhorebeek I, van den Heuvel I, et al. Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study. Lancet. 2009; 373(9663):547-56.
[37] Pacelli F, Bossola M, Papa V, Malerba M, Modesti C, Sgadari A, et al. Enteral vs parenteral nutrition after major abdominal surgery: an even match. Archives of surgery. 2001;136(8):933-6.
[38] De Jonghe B, Appere-De-Vechi C, Fournier M, Tran B, Merrer J, Melchior J-C, et al. A prospective survey of nutritional support practices in intensive care unit patients: what is prescribed? What is delivered? Critical care medicine. 2001; 29(1):8-12.
[39] Klek S, Sierzega M, Szybinski P, Szczepanek K, Scislo L, Walewska E, et al. Perioperative nutrition in malnourished surgical cancer patients–a prospective, randomized, controlled clinical trial. Clinical nutrition. 2011;30(6):708-13.
[40] Pontes-Arruda A, Zaloga G, Wischmeyer P, Turpin R, Liu FX, Mercaldi C. Is there a difference in bloodstream infections in critically ill patients associated with ready-to-use versus compounded parenteral nutrition? Clinical nutrition. 2012;31(5):728-34.
[41] Turpin R, Solem C, Pontes-Arruda A, Sanon M, Mehta S, Liu FX, et al. The impact of parenteral nutrition preparation on bloodstream infection risk and costs. European journal of clinical nutrition. 2014;68(8):953.
[42] Nachvak M, Hedayati S, Hejazi N, Motamedi Motlagh A, Shafizade A, Shojaee M. Nutritional assessment in ICU patients with enteral feeding in Amol hospitals. Razi Journal of Medical Sciences. 2018;24(10):92-104.
[43] Shayesteh F, Poudineh S, Pouryazdanpanah-Kermani M, Sadat Ayoudi S, Norouzy A. Assessment of nutritional intake in intensive care unit patients of Ghaem hospital. medical journal of mashhad university of medical sciences. 2015;58(4):217-24.
[44] Braunschweig CL, Levy P, Sheean PM, Wang X. Enteral compared with parenteral nutrition: a meta-analysis. The American journal of clinical nutrition. 2001;74(4):534-42
[45] Simpson F, Doig GS. Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle. Intensive care medicine. 2005;31(1):12-23.
[46] Elke G, van Zanten AR, Lemieux M, McCall M, Jeejeebhoy KN, Kott M, et al. Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Critical Care. 2016;20(1):117.
[47] Shi J, Wei L, Huang R, Liao L. Effect of combined parenteral and enteral nutrition versus enteral nutrition alone for critically ill patients: a systematic review and meta-analysis. Medicine. 2018; 97(41).
| Files | ||
| Issue | Vol 6 No 1 (2020): Winter |
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| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v6i1.2048 | |
| Keywords | ||
| Enteral nutrition Parenteral nutrition Intensive care unit Systematic review | ||
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How to Cite
1.
Heydari A, Keykha A. Comparing Effects of Enteral and Parenteral Nutrition in Patients Admitted to Intensive Care Units: A Systematic Review. Arch Anesth & Crit Care. 2019;6(1):41-49.
