Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines

被引：623

作者：

Blaser, Annika Reintam ^{[1
,2
]}

Starkopf, Joel ^{[1
,3
]}

Alhazzani, Waleed ^{[4
,5
]}

Berger, Mette M. ^{[6
]}

Casaer, Michael P. ^{[7
]}

Deane, Adam M. ^{[8
]}

Fruhwald, Sonja ^{[9
]}

Hiesmayr, Michael ^{[10
]}

Ichai, Carole ^{[11
]}

Jakob, Stephan M. ^{[12
]}

Loudet, Cecilia I. ^{[13
]}

Malbrain, Manu L. N. G. ^{[14
]}

Gonzalez, Juan C. Montejo ^{[15
]}

Paugam-Burtz, Catherine ^{[16
]}

Poeze, Martijn ^{[17
]}

Preiser, Jean-Charles ^{[18
]}

Singer, Pierre ^{[19
,20
]}

Van Zanten, Arthur R. H. ^{[21
]}

De Waele, Jan ^{[22
]}

Wendon, Julia ^{[23
]}

Wernerman, Jan ^{[24
,25
]}

Whitehouse, Tony ^{[26
]}

Wilmer, Alexander ^{[27
]}

Oudemans-van Straaten, Heleen M. ^{[28
]}

机构：

[1] Univ Tartu, Dept Anaesthesiol & Intens Care, Tartu, Estonia

[2] Lucerne Cantonal Hosp, Ctr Intens Care Med, Luzern, Switzerland

[3] Tartu Univ Hosp, Dept Anaesthesiol & Intens Care, Tartu, Estonia

[4] McMaster Univ, Div Crit Care, Dept Med, Hamilton, ON, Canada

[5] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada

[6] Univ Lausanne Hosp, Serv Adult Intens Care Med & Burns, Lausanne, Switzerland

[7] Univ Hosp Leuven, Dept Intens Care Med, Louvain, Belgium

[8] Univ Adelaide, Discipline Acute Care Med, Adelaide, SA, Australia

[9] Med Univ Graz, Dept Anaesthesiol & Intens Care Med, Graz, Austria

[10] Med Univ Wien, Klin Abt Herz Thorax Gefasschirurg Anasthesie &, Vienna, Austria

[11] Univ Nice, Hop Pasteur 2, Intens Care Unit, Nice, France

[12] Univ Bern, Univ Hosp, Dept Intens Care Med, Bern, Switzerland

[13] Hosp Interzonal Gen Agudos Gen San Martin de La P, Intens Care Unit, Buenos Aires, DF, Argentina

[14] ZNA Stuivenberg, Ziekenhuis Netwerk Antwerpen, Intens Care Unit, Antwerp, Belgium

[15] Hosp Univ 12 Octubre, Dept Intens Care Med, Madrid, Spain

[16] Hop Beaujon, APHP, Anesthesiol & Perioperat Care Med Dept, Clichy, France

[17] Maastricht Univ, Med Ctr, Dept Surg IntensiveCare Med, Maastricht, Netherlands

[18] Univ Libre Bruxelles, Erasme Univ Hosp, Dept Intens Care, Brussels, Belgium

[19] Rabin Med Ctr, Dept Intens Care, Beilinson Campus, Petah Tiqwa, Israel

[20] Tel Aviv Univ, Sackler Sch Med, Anesthesia & Intens Care Div, Tel Aviv, Israel

[21] Gelderse Vallei Hosp, Dept Intens Care Med, Ede, Netherlands

[22] Ghent Univ Hosp, Dept Crit Care Med, Ghent, Belgium

[23] Kings Coll London, Kings Coll Hosp, Div Immunobiol & Transplantat, Dept Intens Care Med, London, England

[24] Karolinska Univ, Huddinge Hosp, Dept Anaesthesiol & Intens Care Med, Stockholm, Sweden

[25] Karolinska Inst, Stockholm, Sweden

[26] Queen Elizabeth Hosp, Dept Crit Care & Anaesthesia, Birmingham, W Midlands, England

[27] Univ Hosp Leuven, Med Intens Care Unit, Leuven, Belgium

[28] Vrije Univ Amsterdam, Med Ctr, Dept Intens Care Med, Amsterdam, Netherlands

来源：

INTENSIVE CARE MEDICINE | 2017年 / 43卷 / 03期

关键词：

Abdominal problems; Parenteral nutrition; Contraindications; GI symptoms; Early enteral nutrition; Delay of enteral nutrition; INTENSIVE-CARE-UNIT; SEVERE ACUTE-PANCREATITIS; INTRAABDOMINAL HYPERTENSION; GASTROINTESTINAL SURGERY; PARENTERAL-NUTRITION; INDUCED HYPOTHERMIA; STRESS ULCERATION; AORTIC-SURGERY; RISK-FACTORS; METAANALYSIS;

D O I：

10.1007/s00134-016-4665-0

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

To provide evidence-based guidelines for early enteral nutrition (EEN) during critical illness. We aimed to compare EEN vs. early parenteral nutrition (PN) and vs. delayed EN. We defined "early" EN as EN started within 48 h independent of type or amount. We listed, a priori, conditions in which EN is often delayed, and performed systematic reviews in 24 such subtopics. If sufficient evidence was available, we performed meta-analyses; if not, we qualitatively summarized the evidence and based our recommendations on expert opinion. We used the GRADE approach for guideline development. The final recommendations were compiled via Delphi rounds. We formulated 17 recommendations favouring initiation of EEN and seven recommendations favouring delaying EN. We performed five meta-analyses: in unselected critically ill patients, and specifically in traumatic brain injury, severe acute pancreatitis, gastrointestinal (GI) surgery and abdominal trauma. EEN reduced infectious complications in unselected critically ill patients, in patients with severe acute pancreatitis, and after GI surgery. We did not detect any evidence of superiority for early PN or delayed EN over EEN. All recommendations are weak because of the low quality of evidence, with several based only on expert opinion. We suggest using EEN in the majority of critically ill under certain precautions. In the absence of evidence, we suggest delaying EN in critically ill patients with uncontrolled shock, uncontrolled hypoxaemia and acidosis, uncontrolled upper GI bleeding, gastric aspirate > 500 ml/6 h, bowel ischaemia, bowel obstruction, abdominal compartment syndrome, and high-output fistula without distal feeding access.

引用

页码：380 / 398

页数：19

共 75 条

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