Different definitions of feeding intolerance and their associations with outcomes of critically ill adults receiving enteral nutrition: a systematic review and meta-analysis

Author:

Li JianboORCID,Wang Lijie,Zhang Huan,Zou Tongjuan,Kang Yan,He Wei,Xu Yuan,Yin WanhongORCID

Abstract

Abstract Background A unified clinical definition of feeding intolerance (FI) is urged for better management of enteral nutrition (EN) in critically ill patients. We aimed to identify optimum clinical FI definitions based on reported evidence. Methods We searched clinical studies comparing FI with non-FI with a clear definition, summarized the evidence by random-effect meta-analyses, and rated the certainty of evidence by the Grading of Recommendations Assessment, Development and Evaluation frameworks. Results Five thousand five hundred twenty-five records were identified, of which 26 eligible studies enrolled 25,189 adult patients. Most patient-centered outcomes were associated with FI overall. Low to very low certainty evidence established FI defined as large gastric residual volume (GRV) ≥ 250 ± 50 mL combined with any other gastrointestinal symptoms (GIS) had a significant association with high mortalities in particular all-cause hospital mortality (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.40–2.57), the incidence of pneumonia (OR 1.54, 95% CI 1.13–2.09) and prolonged length of hospital stay (mean difference 4.20, 95% CI 2.08–6.32), with a moderate hospital prevalence (41.49%, 95% CI 31.61–51.38%). 3-day enteral feeding (EF) delivered percentage < 80% had a moderate hospital prevalence (38.23%, 95% CI 24.88–51.58) but a marginally significant association with all-cause hospital mortality (OR 1.90, 95% CI 1.03–3.50). Conclusions In critically ill adult patients receiving EN, the large-GRV-centered GIS to define FI seemed to be superior to 3-day EF-insufficiency in terms of both close associations with all-cause hospital mortality and acceptable hospital prevalence (Registered PROSPERO: CRD42022326273). Trial registration: The protocol for this review and meta-analysis was registered with PROSPERO: CRD42022326273. Registered 10 May 2022.

Funder

Sichuan Province Science and Technology Department Project

Post Doctoral Research Fund, West China Hospital, Sichuan University

Chinese Foundation for Hepatitis Prevention and Control-TianQing Liver Disease Research Fund Subject

Publisher

Springer Science and Business Media LLC

Subject

Critical Care and Intensive Care Medicine

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