Higher versus lower enteral calorie delivery and gastrointestinal dysfunction in critical illness: a systematic review and meta-analysis
Abstract
Background and aims In critical illness, enteral nutrition (EN) is frequently limited by gastrointestinal (GI) dysfunction. The aim of this systematic review and meta-analysis was to determine relationships between enteral calorie delivery and GI dysfunction in critically ill adults. Methods MEDLINE, EMCARE, EMBASE, and CINAHL databases were searched from 1 January 2000 to 11 August 2021 to identify parallel group randomised controlled trials of an EN intervention that resulted in a significant difference in calorie delivery between groups and reported at least one outcome relating to GI dysfunction. Study groups were categorised as 'higher' or 'lower' calorie delivery and data were extracted on study interventions, GI dysfunction and clinical outcomes. Extracted data were aggregated using a random effects model and presented as risk ratio with 95% confidence intervals. A P-value <0.05 was considered significant. The risk of publication bias was assessed graphically using a funnel plot. Results From 13 studies involving 6824 patients the mean calorie delivery in the higher calorie group was 1673 ± 468 kcal/day compared to 1121 ± 312 kcal/day in the lower calorie group. The higher calorie group had an increased risk of a large (any volume ≥300 ml) gastric residual volume (GRV) (RR 1.40; 95% CI 1.09, 1.80; P = 0.009) and prokinetic administration (RR 1.18; 95% CI 1.11, 1.27; P < 0.00001). There were no between group differences in the presence of vomiting/regurgitation (RR 0.93; 95% CI 0.58, 1.49; P = 0.76), diarrhoea (RR 1.12; 95% CI 0.93, 1.35; P = 0.22) or abdominal distension (RR 0.71; 95% CI 0.49, 1.04; P = 0.08). There was no evidence of publication bias. Conclusion Higher calorie delivery is associated with increased rates of GRV≥300 ml and prokinetic administration, but not vomiting/regurgitation, diarrhoea or abdominal distension. Other No funding was received for the conduct of this systematic review and meta-analysis. The protocol was prospectively registered with PROSPERO (CRD42021268876).
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Energy-dense feed delivery is associated with increased prokinetic use, but does not affect other outcomes.
“Energy-dense feed delivery is associated with increased prokinetic use, but does not affect other outcomes [37].”
From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [37]
RCTs did not confirm the expected benefit of higher protein intakes alone, or combined with physical activity or energy.
“However, RCTs did not confirm the expected benefit of higher protein intakes alone, or combined with physical activity or energy [37,54,58].”
From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [37]
Cites
PRISMA-P Group, Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., & Stewart, L. A. (2015) · Systematic Reviews · doi:10.1186/2046-4053-4-1 · Cited by 26,223 · see citing works
ESPEN guideline on clinical nutrition in the intensive care unit.
Singer, P., Blaser, A. R., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., Hiesmayr, M., Mayer, K., Montejo, J. C., Pichard, C., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.08.037 · Cited by 2,904 · see citing works
Morrison, A., Polisena, J., Husereau, D., Moulton, K., Clark, M., Fiander, M., Mierzwinski-Urban, M., Clifford, T., Hutton, B., & Rabb, D. (2012) · International Journal of Technology Assessment in Health Care · doi:10.1017/s0266462312000086 · Cited by 1,257 · see citing works
Reignier, J., Boisramé-Helms, J., Brisard, L., Lascarrou, J.-B., Ait Hssain, A., Anguel, N., Argaud, L., Asehnoune, K., Asfar, P., Bellec, F., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(17)32146-3 · Cited by 595 · see citing works
Energy-dense versus routine enteral nutrition in the critically ill
The TARGET Investigators (2018) · New England Journal of Medicine · doi:10.1056/nejmoa1811687 · Cited by 345 · see citing works
Erythromycin improves gastric emptying in critically ill patients intolerant of nasogastric feeding
Chapman, M. J., Fraser, R. J., Kluger, M. T., Buist, M. D., & De Nichilo, D. J. (2000) · Critical Care Medicine · doi:10.1097/00003246-200007000-00026 · Cited by 163 · see citing works
Self-citationEnteral Feeding Intolerance: Updates in Definitions and Pathophysiology
Reintam Blaser, A., Deane, A. M., Preiser, J., Arabi, Y. M., & Jakob, S. M. (2021) · Nutrition in Clinical Practice · doi:10.1002/ncp.10599 · Cited by 156 · see citing works
Moses, V., Mahendri, N. V., John, G., Peter, J. V., & Ganesh, A. (2009) · Clinical Toxicology · doi:10.1080/15563650902936664 · Cited by 29 · see citing works
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ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit
Singer, P., Blaser, A. R., Berger, M. M., Calder, P. C., Casaer, M., Hiesmayr, M., Mayer, K., Montejo-Gonzalez, J. C., Pichard, C., Preiser, J.-C., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.07.011 · Cited by 793 · see citing works
- Authors
- Murthy, T. A., Plummer, M. P., Tan, E., Chapman, M. J., & Chapple, L.-A. S.
- Affiliations
- Royal Adelaide Hospital (AU)
- The Royal Melbourne Hospital (AU)
- ORCID
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2022-10
- Volume
- 41
- Issue
- 10
- Pages
- 2185-2194
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W4292380030
- Cited by
- 16
- References
- 8
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 2 · 2023: 5
- FWCI
- 0.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Keywords
- enteral nutrition, gastrointestinal dysfunction, critical illness, gastric residual volume, prokinetic agents, diarrhea, abdominal distension, critically ill adults, feeding intolerance, publication bias, risk of bias assessment, meta-epidemiology
- MeSH terms
- Adult, Energy Intake, Diarrhea, Enteral Nutrition, Gastrointestinal Diseases, Humans, Vomiting, Critical Illness
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