Predictors of enteral nutrition feeding intolerance in critically ill patients: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

CHEN Xiaojie ^1,2 ,  DUAN Xia ³ , TAO Li ²

1. Tongji University School of Medicine, Shanghai 200092, P. R. China;
2. Nursing Department, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, P. R. China;
3. Nursing Department, the First Maternity and Infant Hospital Affiliated to Tongji University, Shanghai 200126, P. R. China;

Corresponding author：

DUAN Xia, Email: bamboo-714@163.com

Keywords：

Enteral nutrition; Feeding intolerance; Predictors; Meta-analysis; Evidence-based nursing

DOI：

10.7507/1672-2531.202303035

Video：

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Objective To systematically review the predictors of enteral nutrition feeding intolerance in critically ill patients. Methods The PubMed, Web of Science, Cochrane Library, Embase, CNKI, WanFang Data, VIP and CBM databases were searched to collect relevant observational studies from the inception to 6 August, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 18 studies were included, including 28 847 patients. The results of the meta-analysis showed that gender, age, severity of illness, hypo-albuminemia, length of stay, postpyloric feeding, mechanical ventilation and mechanical ventilation time, use of prokinetics, use of sedation drugs, use of vasoactive drugs and use of antibiotics were predictors of enteral nutrition feeding intolerance in critically ill patients, among which postpyloric feeding (OR=0.46, 95%CI 0.29 to 0.71, P<0.01) was a protective factor. Conclusion According to the influencing factors, the medical staff can formulate a targeted enteral nutrition program at the time of admission to the ICU to reduce the occurrence of feeding intolerance. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.

Citation： CHEN Xiaojie, DUAN Xia, TAO Li. Predictors of enteral nutrition feeding intolerance in critically ill patients: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2023, 23(11): 1299-1304. doi: 10.7507/1672-2531.202303035 Copy

1.	McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A. S. P. E. N. ). JPEN J Parenter Enteral Nutr, 2016, 40(2): 159-211.
2.	刘华, 米元元, 黄培培, 等. 危重症患者肠内营养喂养不耐受的研究进展. 护士进修杂志, 2021, 36(4): 333-338.
3.	Jenkins B, Calder PC, Marino LV. A systematic review of the definitions and prevalence of feeding intolerance in critically ill adults. Clin Nutr ESPEN, 2022, 49: 92-102.
4.	米元元, 沈月, 黄海燕, 等. ICU患者肠内营养并发腹泻证据汇总. 护理学报, 2017, 24(21): 58-66.
5.	Chen W, Wang H, Chen Y, et al. The independent risk factors of early diarrhoea in enteral nutrition for ICU patients. J Int Med Res, 2019, 47(10): 4929-4939.
6.	张伟, 江海娇, 姜小敢, 等. 危重病人肠内营养喂养不耐受危险因素的Meta分析. 肠外与肠内营养, 2020, 27(5): 313-320.
7.	Reintam Blaser A, Malbrain ML, Starkopf J, et al. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Med, 2012, 38(3): 384-394.
8.	Gungabissoon U, Hacquoil K, Bains C, et al. Prevalence, risk factors, clinical consequences, and treatment of enteral feed intolerance during critical illness. JPEN J Parenter Enteral Nutr, 2015, 39(4): 441-448.
9.	Sabino KM, Fuller J, May S, et al. Safety and tolerance of enteral nutrition in the medical and surgical intensive care unit patient receiving vasopressors. Nutr Clin Pract, 2021, 36(1): 192-200.
10.	Heyland DK, Ortiz A, Stoppe C, et al. Incidence, risk factors, and clinical consequence of enteral feeding intolerance in the mechanically ventilated critically ill: an analysis of a multicenter, multiyear database. Crit Care Med, 2021, 49(1): 49-59.
11.	Atasever AG, Ozcan PE, Kasali K, et al. The frequency, risk factors, and complications of gastrointestinal dysfunction during enteral nutrition in critically ill patients. Ther Clin Risk Manag, 2018, 14: 385-391.
12.	Mentec H, Dupont H, Bocchetti M, et al. Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Crit Care Med, 2001, 29(10): 1955-1961.
13.	Gacouin A, Camus C, Gros A, et al. Constipation in long-term ventilated patients: associated factors and impact on intensive care unit outcomes. Crit Care Med, 2010, 38(10): 1933-1938.
14.	Wang K, McIlroy K, Plank LD, et al. Prevalence, outcomes, and management of enteral tube feeding intolerance: a retrospective cohort study in a tertiary center. JPEN J Parenter Enteral Nutr, 2017, 41(6): 959-967.
15.	Arunachala Murthy T, Chapple LS, Lange K, et al. Gastrointestinal dysfunction during enteral nutrition delivery in intensive care unit (ICU) patients: risk factors, natural history, and clinical implications. A post-hoc analysis of The Augmented versus Routine approach to Giving Energy Trial (TARGET). Am J Clin Nutr, 2022, 116(2): 589-598.
16.	Saran D, Brody RA, Stankorb SM, et al. Gastric vs small bowel feeding in critically ill neurologically injured patients: results of a multicenter observational study. JPEN J Parenter Enteral Nutr, 2015, 39(8): 910-916.
17.	Yu K, Guo N, Zhang D, et al. Prevalence and risk factors of enteral nutrition intolerance in intensive care unit patients: a retrospective study. Chin Med J (Engl), 2022, 135(15): 1814-1820.
18.	Hu B, Sun R, Wu A, et al. Prognostic value of prolonged feeding intolerance in predicting all-cause mortality in critically ill patients: a multicenter, prospective, observational study. JPEN J Parenter Enteral Nutr, 2020, 44(5): 855-865.
19.	耿照静, 殷文超, 焦洪波, 等. ICU内科危重症患者肠内营养喂养不耐受情况及其影响因素分析. 中国现代医生, 2022, 60(4): 105-107,111.
20.	曹文祯. 机械通气患者早期肠内营养的耐受性现状及喂养不耐受影响因素分析. 济南: 山东大学, 2020.
21.	任珊, 何聪, 李亚轻, 等. 脓毒症病人肠内营养不耐受影响因素分析. 肠外与肠内营养, 2018, 25(6): 355-358.
22.	陈琳, 谌艳芳, 余爱华, 等. 神经内科危重症病人肠内营养喂养不耐受现状及其影响因素. 护理研究, 2021, 35(7): 1285-1289.
23.	周田田, 王保荣, 朱小芳, 等. ICU脓毒症患者肠内营养喂养不耐受的相关因素分析. 护理学报, 2017, 24(16): 6-9.
24.	陈英华. 浙江省ICU患者肠内营养不耐受现状及影响因素分析. 湖州: 湖州师范学院, 2016.
25.	史颜梅, 白琳, 周亚婷, 等. 肠内营养病人发生腹泻的影响因素研究进展. 护理研究, 2017, 31(14): 1673-1676.
26.	Reintam Blaser A, Deane AM, Preiser JC, et al. Enteral feeding intolerance: updates in definitions and pathophysiology. Nutr Clin Pract, 2021, 36(1): 40-49.
27.	Liu Y, Wang Y, Zhang B, et al. Gastric-tube versus post-pyloric feeding in critical patients: a systematic review and meta-analysis of pulmonary aspiration- and nutrition-related outcomes. Eur J Clin Nutr, 2021, 75(9): 1337-1348.
28.	Mutlu GM, Mutlu EA, Factor P. GI complications in patients receiving mechanical ventilation. Chest, 2001, 119(4): 1222-1241.
29.	房玉丽, 王耀丽, 麻媛媛, 等. 重型颅脑损伤患者喂养不耐受护理研究进展. 护理学杂志, 2021, 36(20): 104-106.
30.	Hammas B, Thörn SE, Wattwil M. Propofol and gastric effects of morphine. Acta Anaesthesiol Scand, 2001, 45(8): 1023-1027.
31.	Ritz MA, Fraser R, Tam W, et al. Impacts and patterns of disturbed gastrointestinal function in critically ill patients. Am J Gastroenterol, 2000, 95(11): 3044-3052.
32.	Chernevskaya E, Beloborodova N, Klimenko N, et al. Serum and fecal profiles of aromatic microbial metabolites reflect gut microbiota disruption in critically ill patients: a prospective observational pilot study. Crit Care, 2020, 24(1): 312.
33.	刘桂英, 张艳艳. 危重患者肠内营养喂养不耐受危险因素的meta分析. 中国医药科学, 2022, 12(5): 48-52.

1. McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A. S. P. E. N. ). JPEN J Parenter Enteral Nutr, 2016, 40(2): 159-211.
2. 刘华, 米元元, 黄培培, 等. 危重症患者肠内营养喂养不耐受的研究进展. 护士进修杂志, 2021, 36(4): 333-338.
3. Jenkins B, Calder PC, Marino LV. A systematic review of the definitions and prevalence of feeding intolerance in critically ill adults. Clin Nutr ESPEN, 2022, 49: 92-102.
4. 米元元, 沈月, 黄海燕, 等. ICU患者肠内营养并发腹泻证据汇总. 护理学报, 2017, 24(21): 58-66.
5. Chen W, Wang H, Chen Y, et al. The independent risk factors of early diarrhoea in enteral nutrition for ICU patients. J Int Med Res, 2019, 47(10): 4929-4939.
6. 张伟, 江海娇, 姜小敢, 等. 危重病人肠内营养喂养不耐受危险因素的Meta分析. 肠外与肠内营养, 2020, 27(5): 313-320.
7. Reintam Blaser A, Malbrain ML, Starkopf J, et al. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Med, 2012, 38(3): 384-394.
8. Gungabissoon U, Hacquoil K, Bains C, et al. Prevalence, risk factors, clinical consequences, and treatment of enteral feed intolerance during critical illness. JPEN J Parenter Enteral Nutr, 2015, 39(4): 441-448.
9. Sabino KM, Fuller J, May S, et al. Safety and tolerance of enteral nutrition in the medical and surgical intensive care unit patient receiving vasopressors. Nutr Clin Pract, 2021, 36(1): 192-200.
10. Heyland DK, Ortiz A, Stoppe C, et al. Incidence, risk factors, and clinical consequence of enteral feeding intolerance in the mechanically ventilated critically ill: an analysis of a multicenter, multiyear database. Crit Care Med, 2021, 49(1): 49-59.
11. Atasever AG, Ozcan PE, Kasali K, et al. The frequency, risk factors, and complications of gastrointestinal dysfunction during enteral nutrition in critically ill patients. Ther Clin Risk Manag, 2018, 14: 385-391.
12. Mentec H, Dupont H, Bocchetti M, et al. Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Crit Care Med, 2001, 29(10): 1955-1961.
13. Gacouin A, Camus C, Gros A, et al. Constipation in long-term ventilated patients: associated factors and impact on intensive care unit outcomes. Crit Care Med, 2010, 38(10): 1933-1938.
14. Wang K, McIlroy K, Plank LD, et al. Prevalence, outcomes, and management of enteral tube feeding intolerance: a retrospective cohort study in a tertiary center. JPEN J Parenter Enteral Nutr, 2017, 41(6): 959-967.
15. Arunachala Murthy T, Chapple LS, Lange K, et al. Gastrointestinal dysfunction during enteral nutrition delivery in intensive care unit (ICU) patients: risk factors, natural history, and clinical implications. A post-hoc analysis of The Augmented versus Routine approach to Giving Energy Trial (TARGET). Am J Clin Nutr, 2022, 116(2): 589-598.
16. Saran D, Brody RA, Stankorb SM, et al. Gastric vs small bowel feeding in critically ill neurologically injured patients: results of a multicenter observational study. JPEN J Parenter Enteral Nutr, 2015, 39(8): 910-916.
17. Yu K, Guo N, Zhang D, et al. Prevalence and risk factors of enteral nutrition intolerance in intensive care unit patients: a retrospective study. Chin Med J (Engl), 2022, 135(15): 1814-1820.
18. Hu B, Sun R, Wu A, et al. Prognostic value of prolonged feeding intolerance in predicting all-cause mortality in critically ill patients: a multicenter, prospective, observational study. JPEN J Parenter Enteral Nutr, 2020, 44(5): 855-865.
19. 耿照静, 殷文超, 焦洪波, 等. ICU内科危重症患者肠内营养喂养不耐受情况及其影响因素分析. 中国现代医生, 2022, 60(4): 105-107,111.
20. 曹文祯. 机械通气患者早期肠内营养的耐受性现状及喂养不耐受影响因素分析. 济南: 山东大学, 2020.
21. 任珊, 何聪, 李亚轻, 等. 脓毒症病人肠内营养不耐受影响因素分析. 肠外与肠内营养, 2018, 25(6): 355-358.
22. 陈琳, 谌艳芳, 余爱华, 等. 神经内科危重症病人肠内营养喂养不耐受现状及其影响因素. 护理研究, 2021, 35(7): 1285-1289.
23. 周田田, 王保荣, 朱小芳, 等. ICU脓毒症患者肠内营养喂养不耐受的相关因素分析. 护理学报, 2017, 24(16): 6-9.
24. 陈英华. 浙江省ICU患者肠内营养不耐受现状及影响因素分析. 湖州: 湖州师范学院, 2016.
25. 史颜梅, 白琳, 周亚婷, 等. 肠内营养病人发生腹泻的影响因素研究进展. 护理研究, 2017, 31(14): 1673-1676.
26. Reintam Blaser A, Deane AM, Preiser JC, et al. Enteral feeding intolerance: updates in definitions and pathophysiology. Nutr Clin Pract, 2021, 36(1): 40-49.
27. Liu Y, Wang Y, Zhang B, et al. Gastric-tube versus post-pyloric feeding in critical patients: a systematic review and meta-analysis of pulmonary aspiration- and nutrition-related outcomes. Eur J Clin Nutr, 2021, 75(9): 1337-1348.
28. Mutlu GM, Mutlu EA, Factor P. GI complications in patients receiving mechanical ventilation. Chest, 2001, 119(4): 1222-1241.
29. 房玉丽, 王耀丽, 麻媛媛, 等. 重型颅脑损伤患者喂养不耐受护理研究进展. 护理学杂志, 2021, 36(20): 104-106.
30. Hammas B, Thörn SE, Wattwil M. Propofol and gastric effects of morphine. Acta Anaesthesiol Scand, 2001, 45(8): 1023-1027.
31. Ritz MA, Fraser R, Tam W, et al. Impacts and patterns of disturbed gastrointestinal function in critically ill patients. Am J Gastroenterol, 2000, 95(11): 3044-3052.
32. Chernevskaya E, Beloborodova N, Klimenko N, et al. Serum and fecal profiles of aromatic microbial metabolites reflect gut microbiota disruption in critically ill patients: a prospective observational pilot study. Crit Care, 2020, 24(1): 312.
33. 刘桂英, 张艳艳. 危重患者肠内营养喂养不耐受危险因素的meta分析. 中国医药科学, 2022, 12(5): 48-52.

Chinese Journal of Evidence-Based Medicine

Predictors of enteral nutrition feeding intolerance in critically ill patients: a meta-analysis

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