The incidence and influencing factors of early enteral nutritional feeding interruptions in critically ill patients: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YANG Xiaojuan ^1,2 ,  WANG Jing ^2,3 , ZOU Xiaocui ^2,4 , LI Wei ^1,2 , LI Rong ^2,5 , MAO Xiaorong ^2,6 , WEN Qing ^2,7 , XU Chunyi ¹ , FAN Yu ²

1. Department of Burns, Sichuan Provincial People's Hospital, Chengdu 610072, P. R. China;
2. School of Medicine, University of Electronic Science and Technology of China, Chengdu 610054, P. R. China;
3. Department of Nutrition, Sichuan Provincial People's Hospital, Chengdu 610072, P. R. China;
4. Department of Hepatobiliary, Sichuan Provincial People's Hospital, Chengdu 610072, P. R. China;
5. Department of Maternity, Sichuan Provincial People's Hospital, Chengdu 610072, P. R. China;
6. Department of Nursing, Sichuan Provincial People's Hospital, Chengdu 610072, P. R. China;
7. Cardiac Intensive Care Unit, Sichuan Provincial People's Hospital, Chengdu 610072, P. R. China;

Corresponding author：

WANG Jing, Email: 965556018@qq.com

Keywords：

Critically ill patients; Early enteral nutrition; Feeding interruptions; Incidence; Influencing factors; Meta-analysis

DOI：

10.7507/1672-2531.202402018

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Objective To systematically review the incidence and influencing factors of early enteral nutritional feeding interruptions in critically ill patients. Methods The PubMed, Web of Science, Embase, Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect observational studies on the early enteral nutritional feeding interruptions in critically ill patients from inception to January 2, 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using Stata 17.0 software. Results A total of 12 studies including 1 121 patients were included. Meta-analysis showed that the incidence of early enteral nutritional feeding interruptions in critically ill patients was 75.0% (95%CI 64.0% to 84.0%). Influenced by feeding intolerance, airway management, tube problems, radiological examination, and endoscopy, surgery and so on, interruptions of early enteral nutritional feeding frequently occur in critically ill patients. Conclusion Current evidence shows that early enteral feeding interruptions in critically ill patients are affected by many factors, and the incidence is high. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.

Citation： YANG Xiaojuan, WANG Jing, ZOU Xiaocui, LI Wei, LI Rong, MAO Xiaorong, WEN Qing, XU Chunyi, FAN Yu. The incidence and influencing factors of early enteral nutritional feeding interruptions in critically ill patients: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2024, 24(8): 921-925. doi: 10.7507/1672-2531.202402018 Copy

1.	Reintam Blaser A, Starkopf J, Alhazzani W, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med, 2017, 43(3): 380-398.
2.	孙仁华, 江荣林, 黄曼, 等. 重症患者早期肠内营养临床实践专家共识. 中华危重病急救医学, 2018, 30(8): 715-721.
3.	McClave SA, DiBaise JK, Mullin GE, et al. ACG clinical guideline: nutrition therapy in the adult hospitalized patient. Am J Gastroenterol, 2016, 111(3): 315-334.
4.	左俊焘, 李嘉琪, 徐瑶, 等. 重症病人肠内营养中断现状及其对热卡达标的影响研究. 肠外与肠内营养, 2023, 30(3): 166-170.
5.	Onuk S, Ozer NT, Savas N, et al. Enteral nutrition interruptions in critically ill patients: a prospective study on reasons, frequency and duration of interruptions of nutritional support during ICU stay. Clin Nutr ESPEN, 2022, 52: 178-183.
6.	Kasti AN, Theodorakopoulou M, Katsas K, et al. Factors associated with interruptions of enteral nutrition and the impact on macro- and micronutrient deficits in ICU patients. Nutrients, 2023, 15(4): 917.
7.	Padar M, Uusvel G, Starkopf L, et al. Implementation of enteral feeding protocol in an intensive care unit: before-and-after study. World J Crit Care Med, 2017, 6(1): 56-64.
8.	李阳洋, 邵小平, 蒋卓娟, 等. 早期肠内营养集束化喂养方案对重症患者营养热卡达标率及喂养不耐受的效果研究. 军事护理, 2022, 39(9): 41-44.
9.	宫雪梅, 叶向红, 邢娟, 等. 重症病人早期肠内营养喂养中断原因的系统评价. 肠外与肠内营养, 2018, 25(5): 285-290.
10.	曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
11.	程志强, 张宝珍, 李夏欣, 等. 危重症患者ICU后心理功能障碍发生率及危险因素的Meta分析. 军事护理, 2023, 40(8): 77-81.
12.	王丹, 翟俊霞, 牟振云, 等. Meta分析中的异质性及其处理方法. 中国循证医学杂志, 2009, 9(10): 1115-1118.
13.	Doleman B, Freeman SC, Lund JN, et al. Funnel plots may show asymmetry in the absence of publication bias with continuous outcomes dependent on baseline risk: presentation of a new publication bias test. Res Synth Methods, 2020, 11(4): 522-534.
14.	韩珍, 叶向红, 张锐, 等. 普外科重症患者肠内营养中断影响因素分析及对预后影响的研究. 中国实用护理杂志, 2022, 38(28): 2203-2208.
15.	van Nieuwkoop MM, Ramnarain D, Pouwels S. Enteral nutrition interruptions in the intensive care unit: a prospective study. Nutrition, 2022, 96: 111580.
16.	Habib M, Murtaza HG, Kharadi N, et al. Interruptions to enteral nutrition in critically ill patients in the intensive care unit. Cureus, 2022, 14(3): e22821.
17.	李娜. 重症神经系统疾病患者喂养不耐受现状及影响因素分析. 兰州: 兰州大学, 2021.
18.	Salciute-Simene E, Stasiunaitis R, Ambrasas E, et al. Impact of enteral nutrition interruptions on underfeeding in intensive care unit. Clin Nutr, 2021, 40(3): 1310-1317.
19.	宫雪梅, 叶向红, 武燕, 等. 重症患者早期肠内营养喂养中断现状的调查研究. 中华现代护理杂志, 2019, 25(13): 1646-1650.
20.	Peev MP, Yeh DD, Quraishi SA, et al. Causes and consequences of interrupted enteral nutrition: a prospective observational study in critically ill surgical patients. JPEN J Parenter Enteral Nutr, 2015, 39(1): 21-27.
21.	Czapran A, Headdon W, Deane AM, et al. International observational study of nutritional support in mechanically ventilated patients following burn injury. Burns, 2015, 41(3): 510-518.
22.	Yip KF, Rai V, Wong KK. Evaluation of delivery of enteral nutrition in mechanically ventilated Malaysian ICU patients. BMC Anesthesiol, 2014, 14: 127.
23.	Kim H, Stotts NA, Froelicher ES, et al. Enteral nutritional intake in adult korean intensive care patients. Am J Crit Care, 2013, 22(2): 126-135.
24.	Rice TW, Swope T, Bozeman S, et al. Variation in enteral nutrition delivery in mechanically ventilated patients. Nutrition, 2005, 21(7-8): 786-792.
25.	米元元, 卢洁. 重症患者肠内营养中断影响因素及干预策略的研究进展. 护士进修杂志, 2022, 37(10): 886-891.
26.	黄培培, 蔡喆燚, 田飞, 等. ICU肠内营养中断现况调查及影响因素分析. 护士进修杂志, 2023, 38(18): 1704-1709.
27.	米元元. ICU医护人员肠内营养中断知信行量表的编制与应用. 郑州: 郑州大学, 2022.
28.	Adam A, Ibrahim NA, Tah PC, et al. Decision tree model for early use of semi-elemental formula versus standard polymeric formula in critically ill Malaysian patients: a cost-effectiveness study. JPEN J Parenter Enteral Nutr, 2023, 47(8): 1003-1010.
29.	Shahmanyan D, Lawrence JC, Lollar DI, et al. Early feeding after percutaneous endoscopic gastrostomy tube placement in patients who require trauma and surgical intensive care: a retrospective cohort study. JPEN J Parenter Enteral Nutr, 2022, 46(5): 1160-1166.
30.	McCall ME, Adamo A, Latko K, et al. Maximizing nutrition support practice and measuring adherence to nutrition support guidelines in a Canadian tertiary care ICU. J Intensive Care Med, 2018, 33(3): 209-217.
31.	Kozeniecki M, McAndrew N, Patel JJ. Process-related barriers to optimizing enteral nutrition in a tertiary medical intensive care unit. Nutr Clin Pract, 2016, 31(1): 80-85.

1. Reintam Blaser A, Starkopf J, Alhazzani W, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med, 2017, 43(3): 380-398.
2. 孙仁华, 江荣林, 黄曼, 等. 重症患者早期肠内营养临床实践专家共识. 中华危重病急救医学, 2018, 30(8): 715-721.
3. McClave SA, DiBaise JK, Mullin GE, et al. ACG clinical guideline: nutrition therapy in the adult hospitalized patient. Am J Gastroenterol, 2016, 111(3): 315-334.
4. 左俊焘, 李嘉琪, 徐瑶, 等. 重症病人肠内营养中断现状及其对热卡达标的影响研究. 肠外与肠内营养, 2023, 30(3): 166-170.
5. Onuk S, Ozer NT, Savas N, et al. Enteral nutrition interruptions in critically ill patients: a prospective study on reasons, frequency and duration of interruptions of nutritional support during ICU stay. Clin Nutr ESPEN, 2022, 52: 178-183.
6. Kasti AN, Theodorakopoulou M, Katsas K, et al. Factors associated with interruptions of enteral nutrition and the impact on macro- and micronutrient deficits in ICU patients. Nutrients, 2023, 15(4): 917.
7. Padar M, Uusvel G, Starkopf L, et al. Implementation of enteral feeding protocol in an intensive care unit: before-and-after study. World J Crit Care Med, 2017, 6(1): 56-64.
8. 李阳洋, 邵小平, 蒋卓娟, 等. 早期肠内营养集束化喂养方案对重症患者营养热卡达标率及喂养不耐受的效果研究. 军事护理, 2022, 39(9): 41-44.
9. 宫雪梅, 叶向红, 邢娟, 等. 重症病人早期肠内营养喂养中断原因的系统评价. 肠外与肠内营养, 2018, 25(5): 285-290.
10. 曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
11. 程志强, 张宝珍, 李夏欣, 等. 危重症患者ICU后心理功能障碍发生率及危险因素的Meta分析. 军事护理, 2023, 40(8): 77-81.
12. 王丹, 翟俊霞, 牟振云, 等. Meta分析中的异质性及其处理方法. 中国循证医学杂志, 2009, 9(10): 1115-1118.
13. Doleman B, Freeman SC, Lund JN, et al. Funnel plots may show asymmetry in the absence of publication bias with continuous outcomes dependent on baseline risk: presentation of a new publication bias test. Res Synth Methods, 2020, 11(4): 522-534.
14. 韩珍, 叶向红, 张锐, 等. 普外科重症患者肠内营养中断影响因素分析及对预后影响的研究. 中国实用护理杂志, 2022, 38(28): 2203-2208.
15. van Nieuwkoop MM, Ramnarain D, Pouwels S. Enteral nutrition interruptions in the intensive care unit: a prospective study. Nutrition, 2022, 96: 111580.
16. Habib M, Murtaza HG, Kharadi N, et al. Interruptions to enteral nutrition in critically ill patients in the intensive care unit. Cureus, 2022, 14(3): e22821.
17. 李娜. 重症神经系统疾病患者喂养不耐受现状及影响因素分析. 兰州: 兰州大学, 2021.
18. Salciute-Simene E, Stasiunaitis R, Ambrasas E, et al. Impact of enteral nutrition interruptions on underfeeding in intensive care unit. Clin Nutr, 2021, 40(3): 1310-1317.
19. 宫雪梅, 叶向红, 武燕, 等. 重症患者早期肠内营养喂养中断现状的调查研究. 中华现代护理杂志, 2019, 25(13): 1646-1650.
20. Peev MP, Yeh DD, Quraishi SA, et al. Causes and consequences of interrupted enteral nutrition: a prospective observational study in critically ill surgical patients. JPEN J Parenter Enteral Nutr, 2015, 39(1): 21-27.
21. Czapran A, Headdon W, Deane AM, et al. International observational study of nutritional support in mechanically ventilated patients following burn injury. Burns, 2015, 41(3): 510-518.
22. Yip KF, Rai V, Wong KK. Evaluation of delivery of enteral nutrition in mechanically ventilated Malaysian ICU patients. BMC Anesthesiol, 2014, 14: 127.
23. Kim H, Stotts NA, Froelicher ES, et al. Enteral nutritional intake in adult korean intensive care patients. Am J Crit Care, 2013, 22(2): 126-135.
24. Rice TW, Swope T, Bozeman S, et al. Variation in enteral nutrition delivery in mechanically ventilated patients. Nutrition, 2005, 21(7-8): 786-792.
25. 米元元, 卢洁. 重症患者肠内营养中断影响因素及干预策略的研究进展. 护士进修杂志, 2022, 37(10): 886-891.
26. 黄培培, 蔡喆燚, 田飞, 等. ICU肠内营养中断现况调查及影响因素分析. 护士进修杂志, 2023, 38(18): 1704-1709.
27. 米元元. ICU医护人员肠内营养中断知信行量表的编制与应用. 郑州: 郑州大学, 2022.
28. Adam A, Ibrahim NA, Tah PC, et al. Decision tree model for early use of semi-elemental formula versus standard polymeric formula in critically ill Malaysian patients: a cost-effectiveness study. JPEN J Parenter Enteral Nutr, 2023, 47(8): 1003-1010.
29. Shahmanyan D, Lawrence JC, Lollar DI, et al. Early feeding after percutaneous endoscopic gastrostomy tube placement in patients who require trauma and surgical intensive care: a retrospective cohort study. JPEN J Parenter Enteral Nutr, 2022, 46(5): 1160-1166.
30. McCall ME, Adamo A, Latko K, et al. Maximizing nutrition support practice and measuring adherence to nutrition support guidelines in a Canadian tertiary care ICU. J Intensive Care Med, 2018, 33(3): 209-217.
31. Kozeniecki M, McAndrew N, Patel JJ. Process-related barriers to optimizing enteral nutrition in a tertiary medical intensive care unit. Nutr Clin Pract, 2016, 31(1): 80-85.

Chinese Journal of Evidence-Based Medicine

The incidence and influencing factors of early enteral nutritional feeding interruptions in critically ill patients: a meta-analysis

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