PDF(Pubmed)
Abstract：
OBJECTIVE: Medical nutrition therapy provides the opportunity to compensate for muscle wasting and immune response activation during stress and trauma. The objective of this systematic review is to assess the safety and effectiveness of early enteral nutrition (EEN) in adults with sepsis or septic shock.
METHODS: The MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, and ICTRP tools were searched from inception until July 2023. Conference proceedings, the reference lists of included studies, and expert content were queried to identify additional publications. Two review authors completed the study selection, data extraction, and risk of bias assessment; disagreements were resolved through discussion. Inclusion criteria were randomized controlled trials (RCTs) and non-randomized studies (NRSs) comparing the administration of EEN with no or delayed enteral nutrition (DEE) in adult populations with sepsis or septic shock.
RESULTS: Five RCTs (n = 442 participants) and ten NRSs (n = 3724 participants) were included. Low-certainty evidence from RCTs and NRSs suggests that patients receiving EEN could require fewer days of mechanical ventilation (MD -2.65; 95% CI, -4.44-0.86; and MD -2.94; 95% CI, -3.64--2.23, respectively) and may show lower SOFA scores during follow-up (MD -1.64 points; 95% CI, -2.60--0.68; and MD -1.08 points; 95% CI, -1.90--0.26, respectively), albeit with an increased frequency of diarrhea episodes (OR 2.23, 95% CI 1.115-4.34). Even though the patients with EEN show a lower in-hospital mortality rate both in RCTs (OR 0.69; 95% CI, 0.39-1.23) and NRSs (OR 0.89; 95% CI, 0.69-1.13), this difference does not achieve statistical significance. There were no apparent differences for other outcomes.
CONCLUSIONS: Low-quality evidence suggests that EEN may be a safe and effective intervention for the management of critically ill patients with sepsis or septic shock.
METHODS: The MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, and ICTRP tools were searched from inception until July 2023. Conference proceedings, the reference lists of included studies, and expert content were queried to identify additional publications. Two review authors completed the study selection, data extraction, and risk of bias assessment; disagreements were resolved through discussion. Inclusion criteria were randomized controlled trials (RCTs) and non-randomized studies (NRSs) comparing the administration of EEN with no or delayed enteral nutrition (DEE) in adult populations with sepsis or septic shock.
RESULTS: Five RCTs (n = 442 participants) and ten NRSs (n = 3724 participants) were included. Low-certainty evidence from RCTs and NRSs suggests that patients receiving EEN could require fewer days of mechanical ventilation (MD -2.65; 95% CI, -4.44-0.86; and MD -2.94; 95% CI, -3.64--2.23, respectively) and may show lower SOFA scores during follow-up (MD -1.64 points; 95% CI, -2.60--0.68; and MD -1.08 points; 95% CI, -1.90--0.26, respectively), albeit with an increased frequency of diarrhea episodes (OR 2.23, 95% CI 1.115-4.34). Even though the patients with EEN show a lower in-hospital mortality rate both in RCTs (OR 0.69; 95% CI, 0.39-1.23) and NRSs (OR 0.89; 95% CI, 0.69-1.13), this difference does not achieve statistical significance. There were no apparent differences for other outcomes.
CONCLUSIONS: Low-quality evidence suggests that EEN may be a safe and effective intervention for the management of critically ill patients with sepsis or septic shock.
摘要：
目的：医学营养疗法提供了补偿压力和创伤期间肌肉萎缩和免疫反应激活的机会。本系统评价的目的是评估成人脓毒症或脓毒性休克患者早期肠内营养（EEN）的安全性和有效性。
方法：MEDLINE，Embase,中部,CINAHL,ClinicalTrials.gov,和ICTRP工具从开始到2023年7月进行了搜索。会议记录，纳入研究的参考清单，和专家内容进行了查询，以确定其他出版物。两位综述作者完成了研究选择，数据提取,和偏见风险评估；通过讨论解决了分歧。纳入标准是随机对照试验（RCTs）和非随机研究（NRSs），比较了在败血症或败血症性休克的成人人群中使用EEN和不使用或延迟肠内营养（DEE）的情况。
结果：纳入了5个RCT（n=442名参与者）和10个NRS（n=3724名参与者）。来自RCT和NRS的低确定性证据表明，接受EEN的患者可能需要更少的机械通气天数（MD-2.65；95％CI，-4.44-0.86；和MD-2.94；95％CI，-3.64--2.23），并且在随访期间可能显示较低的SOFA评分（MD-1.64分；95％CI，-2.60--0.68；MD-1.08分；95％CI-26尽管腹泻发作频率增加(OR2.23,95%CI1.115-4.34).即使EEN患者在随机对照试验（OR0.69;95％CI，0.39-1.23）和NRS（OR0.89;95％CI，0.69-1.13）中的住院死亡率均较低，这种差异没有统计学意义。其他结果没有明显差异。
结论：低质量证据表明，EEN可能是处理脓毒症或脓毒性休克的危重患者的安全有效的干预措施。
方法：MEDLINE，Embase,中部,CINAHL,ClinicalTrials.gov,和ICTRP工具从开始到2023年7月进行了搜索。会议记录，纳入研究的参考清单，和专家内容进行了查询，以确定其他出版物。两位综述作者完成了研究选择，数据提取,和偏见风险评估；通过讨论解决了分歧。纳入标准是随机对照试验（RCTs）和非随机研究（NRSs），比较了在败血症或败血症性休克的成人人群中使用EEN和不使用或延迟肠内营养（DEE）的情况。
结果：纳入了5个RCT（n=442名参与者）和10个NRS（n=3724名参与者）。来自RCT和NRS的低确定性证据表明，接受EEN的患者可能需要更少的机械通气天数（MD-2.65；95％CI，-4.44-0.86；和MD-2.94；95％CI，-3.64--2.23），并且在随访期间可能显示较低的SOFA评分（MD-1.64分；95％CI，-2.60--0.68；MD-1.08分；95％CI-26尽管腹泻发作频率增加(OR2.23,95%CI1.115-4.34).即使EEN患者在随机对照试验（OR0.69;95％CI，0.39-1.23）和NRS（OR0.89;95％CI，0.69-1.13）中的住院死亡率均较低，这种差异没有统计学意义。其他结果没有明显差异。
结论：低质量证据表明，EEN可能是处理脓毒症或脓毒性休克的危重患者的安全有效的干预措施。
