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Early versus delayed enteral nutrition support for burn injuries

  1. Jason Wasiak1,*,
  2. Heather Cleland1,
  3. Rachel Jeffery2

Editorial Group: Cochrane Injuries Group

Published Online: 19 JUL 2006

Assessed as up-to-date: 3 DEC 2007

DOI: 10.1002/14651858.CD005489.pub2


How to Cite

Wasiak J, Cleland H, Jeffery R. Early versus delayed enteral nutrition support for burn injuries. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD005489. DOI: 10.1002/14651858.CD005489.pub2.

Author Information

  1. 1

    The Alfred Hospital, Victorian Adult Burns Service, Melbourne, Victoria, Australia

  2. 2

    Alfred Hospital, Nutrition and Dietetics, Prahran, Australia

*Jason Wasiak, Victorian Adult Burns Service, The Alfred Hospital, Commercial Road , Prahran, Melbourne, Victoria, 3181, Australia. J.Wasiak@alfred.org.au . jwasiak1971@gmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 JUL 2006

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

A burn injury increases the body's metabolic demands, and therefore nutritional requirements. Provision of an adequate supply of nutrients is believed to lower the incidence of metabolic abnormalities, thus reducing septic morbidity, improving survival rates, and decreasing hospital length of stay. Enteral nutrition support is the best feeding method for patients who are unable to achieve an adequate oral intake to maintain gastrointestinal functioning, however, its timing (i.e. early versus late) needs to be established.

Objectives

To assess the effectiveness and safety of early versus late enteral nutrition support in adults with burn injury.

Search methods

We searched Cochrane Injuries Group's Specialised Register (Dec 2007), CENTRAL (The Cochrane Library, issue 4, 2007), MEDLINE (1966 to December, 2007), EMBASE (1980 to December 2007) and CINAHL (1982 to May, 2006).

Selection criteria

We included all randomised controlled trials comparing early enteral nutrition support (within 24 hours of injury) versus delayed enteral support (greater than 24 hours).

Data collection and analysis

Two authors used standardised forms to independently extract the data. Each trial was assessed for internal validity with differences resolved by discussion.

Main results

A total of three randomised controlled trials were eligible for inclusion in this review. Results of the studies indicate that evidence about the benefit of early enteral nutritional support on standardised clinical outcomes such as length of hospital stay and mortality, remains inconclusive. Similarly, the question of whether early enteral feeding influenced or decreased metabolic rate as documented in part by our included studies, remains uncertain.

Authors' conclusions

This systematic review has not found sufficient evidence to support or refute the effectiveness of early versus late enteral nutrition support in adults with burn injury. The trials showed some promising results that would suggest early enteral nutrition support may blunt the hypermetabolic response to thermal injury, but this is insufficient to provide clear guidelines for practice. Further research incorporating larger sample sizes and rigorous methodology that utilises valid and reliable outcome measures, is essential.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Do burns patients who receive early (within 24 hours) nutritional support have better outcomes than those whose nutritional support is delayed (after 24 hours)?

Adult patients with large burns have increased nutrition and energy requirements. If such requirements are not met, it is associated with worse health outcomes including increased infection rates and poorer healing. Patients are often not able to meet the increased requirements through oral feeding alone, thus enteral feeding is often used. Enteral nutrition is provided by inserting a feeding tube via the nose or mouth, into the stomach or small intestine. The feeding tube delivers a liquid formula (enteral nutrition) containing the required nutrients. Enteral feeding is continued until sufficient oral intake is established to meet the patient's need.

Enteral nutrition is essential for the successful management of the burns patient, however there is debate regarding the optimal method and timing of feeding. It is unclear whether providing enteral nutrition from an early stage after injury is preferable to delaying such support. The authors of this review attempted to resolve this uncertainty by examining all high quality trials comparing the effectiveness of initiating enteral nutrition in the early stages after injury (within 24 hours), with delayed (after 24 hours) enteral nutrition, in burns patients over the age of 16 years.

The authors found three studies involving 70 adult burn patients. The results of the studies provide no conclusive evidence for the benefit of early enteral nutritional support compared to delayed support, on outcomes such as length of hospital stay and mortality.

The trials involved a small number of participants and were limited by methodological weaknesses. There is a need for larger, high quality research into the use of early versus delayed feeding in burn patients.

Overall, the authors conclude that there is currently little evidence to support the use of early nutritional support, but more trials are needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

燒傷患者儘早或延遲腸胃道營養支持

燒傷會增加身體代謝需求,因此增加營養需求.提供足夠的營養補充被認為可以降低代謝異常的機率,進而降低並發敗血症,增加存活率及住院天數. 腸胃營養供給是被認為對那些無法從達到足夠經口進食以維持腸胃道功能的病人最好的餵食方法.然而它給與的時間 (早或晚)需被建立.

目標

評估成人燒傷患者早與晚腸道營養供給的效益與安全性.

搜尋策略

我們搜尋Cochrane Central Register of Controlled Trials (The Cochrane Library, issue 1, 2006), Cochrane Injuries Group's Specialised Register, MEDLINE (1966 to May week 1, 2006), EMBASE (1980 to week 17, 2005) and CINAHL (1982 to May week 1, 2006).

選擇標準

我們含括所有比較儘早(受傷24小時內)或延遲(受傷24小時後)腸胃道營養支持的隨機對照試驗.

資料收集與分析

兩位作者用標準的表格獨立擷取資料.每一個試驗都評估內部正確性,若有不同均經討論解決.

主要結論

總共有3個randomised controlled trials合適含括於此回顧.這些研究的結果指出早期腸道營養的維持在標準化的臨床結果如住院天數及死亡率的益處依然無法定論.相同的,早期腸胃道餵食影響或降低代謝率如同在我們含括的研究所提及的疑問依然無法回答.

作者結論

這個系統性的回顧未發現足夠的證據來支持或反駁燒燙傷成人早期相對延遲施與腸道營養支持的效益.這些研究顯現一些支持性的結果建議早期腸胃道支持可能減少對於溫度傷害的過度代謝反應,但這並不足夠來提供工作清楚的指引. 近一步結合大一點的研究數量及使用有效及可信結果測量之嚴謹的方法的研究是必須的.

翻譯人

本摘要由高雄榮民總醫院王曉萍翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

燒傷患者早期(24小時內)的腸道營養供給是否較那些延遲給予(24小時以後)腸道營養有較好的結果?成人患者有大面積燒燙傷慧增加營養及熱量的需求.若這樣的需求不被達成,會有較差的健康結果,包括感染率的增加及癒合較差. 病人通常無法單獨由經口餵食來達到這些增加的需求,因此腸道餵食通常需要. 腸道營養通常經由經由鼻子或嘴巴置放管子至胃或小腸來提供.餵食管遞送含有需要的營養的液體配方(腸道營養). 腸道營養持續至經口進食量已達到病人的需求.腸道營養在成功處理燒燙傷病人是必須的,然而關於餵食的最洽當的方法與時間依然有爭議.受傷後早期的提供腸道營養是否較延遲給予佳尚不清楚.此回顧的作者式途經檢查所有比較超過16歲的燒燙傷病人受傷後早期(24小時內)開始腸道營養與延遲(24小時以後)腸道營養的效果高品質的研究來回答此疑問.作者發現有三個研究包含70個成人燒燙傷患者. 這些研究的結果對於比較早期與晚期腸道營養的好處及留院時間長短和死亡率等癒後無法提供有證據的結論.這些研究只含括少量參予實驗者並受限於研究方法的缺陷. 需要大型, 高品質的研究在於燒燙傷病人的早期相對延遲施與腸道營養支持.總而言之, 作者們總結認為目前少許的證據支持早期腸道營養的使用,但需要更多的研究.