Wasiak J, Cleland H, Jeffery R, et al.
The Cochrane database of systematic reviews. Date of publication 2006 Jul 19;volume (3):CD005489.
1. Cochrane Database Syst Rev. 2006 Jul 19;(3):CD005489.
Early versus delayed enteral nutrition support for burn injuries.
Wasiak J(1), Cleland H, Jeffery R.
Author information:
(1)Alfred Hospital, Victorian Adult Burns Service, Commercial Road, Prahran,
Melbourne, Victoria, Australia 3004. J.Wasiak@alfred.org.au
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 STRATEGY: We searched the Cochrane Central Register of Controlled Trials
(The Cochrane Library, issue 1, 2006), the 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).
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.
DOI: 10.1002/14651858.CD005489.pub2
PMID: 16856098 [Indexed for MEDLINE]
