Background
Methods
Search strategy
Screening and eligibility of records
Parameter | Inclusion criteria | Exclusion criteria |
---|---|---|
Population | Adult tube-fed critically ill patients | Partial EN |
Intervention | Supplementation with pre, pro, or synbiotics | |
Comparison | Placebo or nothing | |
Outcome | Enteral feed volume, Time to reach full enteral nutrition, the prevalence of feed intolerance and related GI complications (diarrhea, distention, high residual volume) | |
Study design | Randomized controlled trials | In vitro studies |
Data extraction and synthesis
Risk of bias assessment
Clinical outcomes
Results
Study identification and selection
Author, year | Population | Design | JADAD score | EN protocol | Type of intervention | ||
---|---|---|---|---|---|---|---|
Delivery vehicle | Intervention /dose/duration | control | |||||
Bleichner et al., 1997 [17] | ICU patients n=128 | Parallel | 5 | NR | NGT or jejunostomy | EN (intact protein standard diet without fiber or lactose) + Saccharomyces boulardii /500 mg four times a day/limited to 21 days or to the withdrawal of EN | EN (intact protein standard diet without fiber or lactose) + placebo |
Schultz et al., 2000 [18] | ICU patients n=44 | Parallel | 2 | NR | Tube feeding | Fiber containing formula+ pectin or fiber-free formula +pectin/ 20ml, twice daily/ 6 days | Fiber containing formula+ placebo Or fiber-free formula +placebo |
Spapen et al., 2001 [19] | ICU patients with severe sepsis or septic shock n= 25 | Parallel | 3 | Start: first 24h, 25cc/h. Increase 25–35 cc/h to 80% target | NGT | EN+ partially hydrolyzed guar/ 22g/l / a maximum of 21 days or to the withdrawal of EN | Fiber-free EN |
Rushdi et al., 2004 [20] | ICU patients with persistent diarrhea n=20 | Parallel | 3 | Start: first 18–24h. Target: 25–35 kcal/kg. First day: 50%, second day: 75%, third day: 100% | NJT | EN+ 2% soluble guar gum (Benefiber)/ 4 days | Fiber-free EN |
Knight et al., 2009 [21] | ICU patients n= 259 | Parallel | 5 | Start: 30cc/h; max: 80cc/h; increase or decrease according to GRV | NGT/ OGT | EN (Nutrison Energy) + Synbiotic 2000 FORTE / twice a day/ to the earliest of the following time point:28 days after admission, death or discharge | EN (Nutrison Energy) + placebo |
Frohmader et al., 2010 [22] | ICU patients n= 45 | Parallel | 5 | Start: first 24h, 20cc/h; increase: 20cc/4h to target. Target: 25–35 kcal/kg | NGT/ OGT/ nasojejunostomy | Fiber-free EN+ probiotic (VSL#3) /twice a day/ mean of 11.9 days | Fiber-free EN+ placebo |
Barraud et al., 2010 [23] | ICU patients with MV n=167 | Parallel | 5 | Starting in the first 24h, 10 kcal/kg, increase to 30–35 kcal/kg | NGT | EN + multi-strain probiotic (Ergyphilus)/ once a day/ until successful weaning (maximum of 28 days) | EN + placebo |
Morrow et al., 2010 [24] | ICU patients with MV n=167 | Parallel | 5 | NR | NGT | EN + probiotic (Lactobacillus rhamnosus GG) / twice a day/ | EN+ inulin-based placebo |
Ferrie and Daley, 2011 [25] | ICU patients with diarrhea n= 36 | Parallel | 5 | NR | Gastric tube | Fiber containing EN+ probiotic (inulin-based Lactobacillus GG)/twice a day/ 7 days | Fiber containing EN+ placebo (inulin) |
Sanaie et al., 2014 [26] | ICU patient n= 40 | Parallel | 5 | Start in first 24h, 25cc/h; increase 25cc/4h to target. Target: 25–30 kcal/kg | NGT | Fiber containing EN+ probiotic (VSL#3)/ twice daily/ 7 days | Fiber containing EN+ placebo |
Majid et al., 2014 [27] | ICU patients n= 22 | Parallel | 5 | Energy estimation based on Schofield equation | NGT | Fiber containing EN+ additional oligofructose/inulin/ 7g per day/ 7days | Fiber containing EN+ placebo |
Malik et al., 2016 [28] | ICU patients n= 60 | Parallel | 5 | 25 kcal/kg. start in first 24–48h, with GRV management | NGT | EN+ multi-strain probiotic/ twice a day/ 7 days | EN+ placebo |
Fazilaty et al., 2018 [29] | Multiple trauma ICU patients n= 40 | Parallel | 5 | Goal: 25–30 kcal/kg, 75% in the 48h | NGT | EN+ prebiotic (oat β-glucan)/ 3g per day/ 21 days | EN+ placebo (maltodextrin) |
Shimizu et al., 2018 [30] | Septic ICU patients with MV n= 72 | Parallel | 3 | Start: 20cc/h; increase: 20cc/h/day to target. Target: 25–30 kcal/kg | NGT | EN +multi-strain probiotic (Yakult BL Seichoyaku) 3 g per day+ prebiotic (galactooligosaccharides) 10g per day/ until EN stop | EN |
Tuncay et al., 2018 [31] | Neurocritical care patients n=46 | Parallel | 1 | Start: 10cc/h; increase: 10cc/8h till 20cc/h; requirement: Schofield equation+stress factor+activity factor+ ventilator support+fever+TEF | Nasofeeding, gastrostomy/PEG | EN with prebiotic content/ 21 days | EN |
Effect on energy intake and feed volume
Prebiotics
Probiotics
Synbiotics
Effect on target calorie achievement
Prebiotics
Probiotics
Effect on diarrhea
Prebiotics
Probiotics
Synbiotics
Effect on length of stay
Study | Energy intake | Achieving the target calorie | Diarrhea | Length of stay | ||||
---|---|---|---|---|---|---|---|---|
Intervention | Control | Intervention | Control | Intervention | Control | Intervention | Control | |
Bleichner et al., 1997 [17] | NR | NR | NR | NR | Prevalence: 18/64 (24%) Days w/ diarrhea per feeding days: 14.2% | Prevalence: 24/64 (38%) Days w/ diarrhea per feeding days: 18.9% | NR | NR |
Schultz et al., 2000 [18] | Meana | Meana | NR | NR | Prevalence: 1/11 (9%) | Prevalence: 4/11 (36%) | Hospital: 34±14.7 ICU: 28±14.6 | Hospital: 24.4±9 ICU: 17.2±8.2 |
Spapen et al., 2001 [19] | NR | NR | Time to: 5±3 days | Time to: 6±3days | Prevalence: 6/13 (46%) Days w diarrhea per feeding days: 16/148(10.8%) | Prevalence: 11/12(92%) Days w diarrhea per feeding days: 46/146 (31.5%) | NR | NR |
Rushdi et al., 2004 [20] | Days 1–4 | Days 1–4 | NR | NR | Liquid stools day1-4 | Liquid stools days 1–4 | NR | NR |
Knight et al., 2009 [21] | Days 1–7 | Days 1–7 | NR | NR | Prevalence: 7/130 (5%) | Prevalence: 9/129 (7%) | ICU: 6 (3–11) | ICU: 7 (3–14) |
Frohmader et al., 2010 [22] | NR | NR | NR | NR | Frequency of liquid stools: 0.53±0.54 | Frequency of liquid stools: 1.05±1.08 | ICU: 7.3±5.7 | ICU: 8.1±4 |
Barraud et al., 2010 [23] | NR | NR | NR | NR | Prevalence: 48/87(55.2) | Prevalence: 42/80(52.5) | Hospital: 26.6±22.3 ICU: 18.7±12.3 | Hospital: 28.9±26.4 ICU: 20.2±20.8 |
Morrow et al., 2010 [24] | NR | NR | NR | NR | Prevalence: 44/70(62.9) Days w/ diarrhea: 5.9±3.8 | Prevalence: 42/68(61.8) Days w/ diarrhea: 4.1±3.7 | Hospital: 21.4±14.9 ICU: 14.8±11.8 | Hospital: 21.7±17.4 ICU: 14.6±11.6 |
Ferrie and Daley, 2011 [25] | NR | NR | Prevalence 16/18 (88.8) | Prevalence 15/18(83.33) | Diarrhea duration: 7.22±3.63 Loose stool per day: 3.14±1.23 | Diarrhea duration: 5.72±2.88 Loose stool per day: 3±1.2 | Hospital: 54.5±31.26 ICU: 32.04±24.46 | Hospital: 59.04±33.92 ICU: 29.75±18.81 |
Sanaie et al., 2014 [26] | Meana | Meana | NR | NR | NR | NR | NR | NR |
Majid et al.,2014 [27] | NR | NR | NR | NR | Prevalence: 11/12 (92) Days w/ diarrhea: 3.9±4.1 | Prevalence: 9/10 (90) Days w/ diarrhea: 3.8±3.5 | NR | NR |
Malik et al., 2016 [28] | NR | NR | Time to: 3±1.75 days | Time to: 7±1.7 days | NR | NR | ICU: 10.9±3.9 | ICU: 15.8±7.8 |
Fazilaty et al., 2018 [29] | Meana | Meana | NR | NR | NR | NR | ICU: 27.55±7.8 | ICU: 31.2±15.8 |
Shimizu et al., 2018 [30] | NR | NR | NR | NR | Incidence of enteritis: 2/35 (6.3) | Incidence of enteritis: 10/37(27) | ICU: 23 (13–43) | ICU: 28 (17–45) |
Tuncay et al., 2018 [31] | Days 1 and 21 | Days 1 and 21 | Prevalence 22 (95.7) | Prevalence 18 (78.3) | Prevalence: 8.7% | Prevalence: 56.5% | Hospital stay <40 days: 56.6% Hospital stay ≥41 days: 43.4% ICU stay <40 days: 69.5% ICU stay ≥41 days: 43.5% | Hospital stay <40 days: 60.9% Hospital stay ≥41 days: 39.1% ICU stay <40 days: 69.5% ICU stay ≥41 days: 30.4% |