Binnekade, J.M.

International Migration, Integration and Social Cohesion online publications

UvA-DARE is a service provided by the library of the University of Amsterdam (https://dare.uva.nl)UvA-DARE (Digital Academic Repository)Review: enteral nutrition reduces infections, need for surgical intervention, andlength of hospital stay more than parenteral nutrition in acute pancreatitis[invited comment on]Binnekade, J.M.Publication date2005Published inEvidence-Based NursingLink to publicationCitation for published version (APA):Binnekade, J. M. (2005). Review: enteral nutrition reduces infections, need for surgicalintervention, and length of hospital stay more than parenteral nutrition in acute pancreatitis[invited comment on]. Evidence-Based Nursing, 8(1), ?.General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s)and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an opencontent license (like Creative Commons).Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, pleaselet the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the materialinaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letterto: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. Youwill be contacted as soon as possible.Download date:11 Mar 2023doi:10.1136/ebn.8.1.19  2005;8;19- Evid. Based Nurs.  Jan M Binnekade    more than parenteral nutrition in acute pancreatitisfor surgical intervention, and length of hospital stay Review: enteral nutrition reduces infections, need http://ebn.bmj.com/cgi/content/full/8/1/19Updated information and services can be found at:  These include: References   http://ebn.bmj.com/cgi/content/full/8/1/19#BIBLThis article cites 3 articles, 1 of which can be accessed free at: Rapid responses http://ebn.bmj.com/cgi/eletter-submit/8/1/19You can respond to this article at:  serviceEmail alertingtop right corner of the article Receive free email alerts when new articles cite this article - sign up in the box at theTopic collections (414 articles) Pancreas and biliary tract   Articles on similar topics can be found in the following collections  Notes    http://www.bmjjournals.com/cgi/reprintformTo order reprints of this article go to:  http://www.bmjjournals.com/subscriptions/ go to: Evidence-Based NursingTo subscribe to  on 24 May 2007 ebn.bmj.comDownloaded from Review: enteral nutrition reduces infections, need for surgicalintervention, and length of hospital stay more than parenteralnutrition in acute pancreatitisMarik PE, Zaloga GP. Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis. BMJ2004;328:1407.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Q What is the efficacy and safety of enteral nutrition (EN) compared with total parenteral nutrition (PN) for patients withacute pancreatitis (AP)?METHODSData sources: Medline (1966 to January 2004), EMBASE/Excerpta Medica, Cochrane Controlled Trials Register, andCochrane Database of Systematic Reviews; bibliographies ofrelevant studies; and experts in the field.Study selection and assessment: randomised controlled trials(RCTs) that compared EN with PN in patients admitted to hospitalwith AP, and included >1 of the outcomes listed below.Methodological quality of individual studies was assessed usingthe 5 point Jadad composite scale.Outcomes: infections (pneumonia, abdominal abscess,pancreatic abscess, wound infection, or bloodstream infection),non-infectious complications (adult respiratory distress syndrome,multiorgan failure, acute pseudocysts, and pancreatic fistula),need for surgical intervention, length of hospital stay, andhospital mortality.MAIN RESULTS6 trials (n=263) met the selection criteria. 4 studies had poor quality(Jadad score (2 out of 5). Meta-analysis was completed using arandom effects model and intention to treat data from individualstudies. Patients who received EN had a lower risk of infection thanthose who received PN, less need for surgical intervention, fewerseptic complications, and shorter hospital stays (mean reduction 2.9days, 95% CI 1.6 to 4.3) (table). The EN and PN groups did not differfor complications other than infections or hospital mortality (table).CONCLUSIONEvidence from primarily low quality trials shows that in patients withacute pancreatitis, enteral nutrition reduces infections, septiccomplications, need for surgical intervention, and length of hospitalstay compared with total parenteral nutrition but does not affectnon-infectious complications or hospital mortality.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .For correspondence: Dr P E Marik, Department of Critical Care Medicine,University of Pittsburgh Medical Center, Pittsburgh, PA, USA. maripe@ccm.upmc.eduSource of funding: no external funding.Enteral nutrition (EN) v parenteral nutrition (PN) for acute pancreatitis*Weighted event ratesOutcomes at hospital discharge Number of studies EN PN RRR (95% CI) NNT (CI)Infections 6 11% 29% 56% (23 to 75) 6 (4 to 12)Septic complications 6 11% 28% 55% (22 to 74) 6 (4 to 12)Surgical intervention 4 11% 19% 52% (1 to 77) 12 (6 to 519)Other non-infectious complications 5 10% 30% 33% (–14 to 60) Not significantHospital mortality 6 8% 12% 32% (–38 to 66) Not significant*Abbreviations defined in glossary; RRR, NNT, and CI calculated from data in article using a random effects model.CommentaryThe review by Marik et al recommends the use of EN for patients withAP. Based on the poor quality of the included studies, the pooledeffect could be an overestimation.1 However, existing studies withvarious levels of evidence also provide support for the use of EN forseverely ill patients.2Patients with AP are a very specific disease population, and the issuesrelated to providing EN to these patients may differ from those related tomore general patient populations. For example, enteral feeding ofpatients with AP requires that nurses be able to recognise the linkbetween deterioration of AP symptoms and possible dislocation of thefeeding tube or symptoms related to an overload of food in the smallintestine. Attention to feeding tube positioning, measurement of gastricretention and EN, and feeding pump controlled administration isimportant for AP patients.Optimal EN in the intensive care unit often fails because EN gets lessattention than other life saving technologies. Studies of feeding intakehave shown that optimal feeding rarely is achieved in .50% of patients.3Therefore, the positive effects shown in efficacy studies may be diluted bythe daily reality of clinical practice. The success of EN feeding will bedetermined largely by the quality of nursing practice.Jan M Binnekade, RN, MScAcademic Medical CentreUniversity of AmsterdamAmsterdam, The Netherlands1 Guyatt G, Rennie D, Hayward R, editors. Users’ Guides Interactive (JAMA).Chicago, IL: JAMA Publishing Group; 2002 (accessed Sep 14, 2004).http://www.usersguides.org2 Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: asystematic review. Crit Care Med 2001;29:2264–70.3 Adam S, Batson S. A study of problems associated with the delivery ofenteral feed in critically ill patients in five ICUs in the UK. Intensive Care Med1997;23:261–6.TREATMENT 19EBN Volume 8 January 2005 evidencebasednursing.com on 24 May 2007 ebn.bmj.comDownloaded from 

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Review: enteral nutrition reduces infections, need for surgical intervention, and length of hospital stay more than parenteral nutrition in acute pancreatitis [invited comment on]

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Review: enteral nutrition reduces infections, need for surgical intervention, and length of hospital stay more than parenteral nutrition in acute pancreatitis [invited comment on]

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