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Comparison of enteral and parenteral nutrition in critically ill patient of Intensive Care Unit: a systematic review

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Eirini-Chrysovalanto Patsiou, Erofili Rousou, Martha Kelesi, Georgia Fasoi
Eirini-Chrysovalanto Patsiou, Erofili Rousou, Martha Kelesi, Georgia Fasoi


Background: The enteral nutrition (EN) is the first choice of  nutritional support for  critically ill patients. Despite the fact that the most common practice is choosing continuous EN, there is a controversy about which is the safest and most effective method of nutrition.

Aim: The aim of this systematic review was the analysis of the effect of EN compared to PN for patients that are hospitalized in ICUs, as a function of to the cost and the time of hospitalisation, the hospital-acquired infections, complications and mortality.

Material and Methods: A systematic literature search was conducted in English and Greek language, of published articles during the past 5 years. Articles were unidentified in electronic databases of PubMed, Cochrane Library and Iatrotek using keywords. Grey literature was also taken involved. Finally, 4 studies were included in the systematic review, after the application of exclusion and inclusion criteria.

Results: Eight hundred thirty-eight articles (838) were recovered using keywords. The studies that were finally included and further analysed consisted of 2 systematic reviews and meta-analyses, one randomised clinical trial, a multicentre controlled randomised trial and a systematic review. The method of nutrition (enteral or parenteral) is not related to mortality. The EN is related to less blood bacterial infections and reduction in the time of hospitalization. On the other hand, it causes more gastrointestinal complications. On average, the cost of parenteral nutrition is higher than intestinal.

Conclusions: The EN is indicated to be the primary nutritional support of ICU-treated patients, with the advantage of reduced haematogenous infections and organ failure, beside the fact that it still is a challenging procedure. Critically ill patients are a heterogeneous group, in which each patient needs a personalised diet, depending on the diagnosis, the time spent in the ICU and the variety of possible complications.



Enteral nutrition; parenteral nutrition; critically ill; ICU, intensive care

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Mogensen KM, Robinson MK, Casey JD, Gunasekera NS, Moromizato T, Rawn JD, Christopher KB. Nutritional status and mortality in the critically ill. Crit Care Med. 2015; 43:2605-15.

Vallejo KP, et al. Current clinical nutrition practices in criti-cally ill patients in Latin America: a multinational observa-tional study.Critical Care. 2017;21:227-37.

Ikram S, Hussain E, Zubairi ABS. Nutrition in intensive care in adults review of the literature and development of evi-dence based feeding protocols. J Pak Med Assoc. 2016;66(9):1154-64.

Padilla PF, Martinez J, Vernooij WMR, Cosp XB, Alonso-Coello P. Nutrition in critically ill adults: A systematic quali-ty assessment of clinical practice guidelines. Clinical Nutri-tion. 2016;35:1219-25.

McClave SA, Beth E. Taylor BE, Martindale RG, Warren MM, Johnson DR, et al. Guidelines for the Provision and Assess-ment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (AS-PEN). JPEN J Parenter Enteral Nutr 2016;40(2):159–211.

Worthington P, Balint J, Bechtold M, Bingham A, Chan LN, Durfee S, et al. When Is Parenteral Nutrition Appropriate? JPEN Journal of parenteral and enteral nutrition. 2017;41(3):324-77.

Nakos, G., Karachaliou, A., Kitsakos, A., Koulouras, V., Kostanti, E., Lachana, A., Papathanakos, G., Papathanasiou, A., Stamati, V., Tigkas, S., Tsagkaris, I. 2015. Nutritional support in the critically ill patients. [Book Chapter]. In Nakos, G., Karachaliou, A., Kitsakos, A., Koulouras, V., Kostanti, E., Lachana, A., Papathanakos, G., Papathanasiou, A., Stamati, V., Tigkas, S., Tsagkaris, I. 2015. Emergency treatment. [ebook] Athens:Hellenic Academic Libraries Link. chapter 19. Available Online at: http://hdl.handle.net/11419/872

Ridley EJ, et al. Supplemental parenteral nutrition versus usual care in critically ill adults: a pilot randomized con-trolled study.Critical Care. 2018;22:12-22.

Pradelli L, Graf S, Pichard C, Berger MM. Supplemental par-enteral nutrition in intensive care patients: A cost saving strategy. Clinical Nutrition. 2018;37:573-9.

Zhang G, Zhang K, Cui W, Hong Y, Zhang Z. The effect of enteral versus parenteral nutrition for critically ill patients: A systematic review and meta-analysis. Journal of clinical anesthesia. 2018;51:62-92.

Lewis SR, Schofield-Robinson OJ, Alderson P, Smith AF. Enteral versus parenteral nutrition and enteral versus a combination of enteral and parenteral nutrition for adults in the intensive care unit. The Cochrane database of sys-tematic reviews. 2018;6:CD012276.

Elke G, van Zanten AR, Lemieux M, McCall M, Jeejeebhoy KN, Kott M, et al. Enteral versus parenteral nutrition in criti-cally ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Crit Care 2016;20(1):117.

Harvey SE, Parrott F, Harrison DA, Sadique MZ, Grieve RD, Canter RR, et. al. A multicentre randomised controlled trial comparing the clinical effectiveness of early nutritional support via the parenteral versus the enteral route in criti-cally ill patients (CALORIES), (http://www.journalslibrary.nihr.ac.uk/hta/volume-20/issue-28#abstract). Health Technol Assess. 2016; 20(28):1-144.

Oshima T, Singer P, Pichard C. Parenteral or enteral nutri-tion: do you have the choice? Current opinion in critical care. 2016;22(4):292-8.

Harvey SE, Parrott F, Harrison DA, Bear DE, Segaran E, Beale R, et al. Trial of the route of early nutritional support in crit-ically ill adults. N Engl J Med. 2014;371:1673–84.


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