Enteral, parenteral nutrition and their combination for adults in the intensive care unit

Added March 17, 2020

Citation: Lewis SR, Schofield-Robinson OJ, Alderson P, et al. Enteral versus parenteral nutrition and enteral versus a combination of enteral and parenteral nutrition for adults in the intensive care unit. Cochrane Database of Systematic Reviews 2018; (6): CD012276.

What is this? Some patients with COVID-19 will become critically ill and need treatment in an intensive care unit (ICU). This may interrupt their feeding routines and reduce appetite or increase nausea and vomiting, leading to malnutrition. Methods of delivery of nutritional requirements include enteral nutrition (EN) and parenteral nutrition (PN), or a combination of both.

In this Cochrane systematic review, the authors searched for randomized trials and quasi-randomized trials comparing EN, PN and the combination in adult ICU patients. They did not restrict by language of publication and conducted searches in October 2017. They included 23 randomized trials and two quasi-randomized trials. A further 11 studies are currently awaiting assessment.

What works: There is low certainty evidence that enteral nutrition may reduce sepsis, based on studies among people with a range of different conditions. Fewer participants vomited if they had parenteral feeding rather than enteral feeding, but the certainty of the evidence is very low.

What doesn’t work: Nothing reported.

What’s uncertain: The effects of the feeding route on many outcomes including hospital mortality, mortality within 90 days or the number of ventilator-free days and adverse events such as pneumonia is uncertain.


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