• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of annsurgLink to Publisher's site
Ann Surg. Aug 1992; 216(2): 172–183.
PMCID: PMC1242589

Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis.

Abstract

This two-part meta-analysis combined data from eight prospective randomized trials designed to compare the nutritional efficacy of early enteral (TEN) and parenteral (TPN) nutrition in high-risk surgical patients. The combined data gave sufficient patient numbers (TEN, n = 118; TPN, n = 112) to adequately address whether route of substrate delivery affected septic complication incidence. Phase I (dropouts excluded) meta-analysis confirmed data homogeneity across study sites, that TEN and TPN groups were comparable, and that significantly fewer TEN patients experienced septic complications (TEN, 18%; TPN, 35%; p = 0.01). Phase II meta-analysis, an intent-to-treat analysis (dropouts included), confirmed that fewer TEN patients developed septic complications. Further breakdown by patient type showed that all trauma and blunt trauma subgroups had the most significant reduction in septic complications when fed enterally. In conclusion, this meta-analysis attests to the feasibility of early postoperative TEN in high-risk surgical patients and that these patients have reduced septic morbidity rates compared with those administered TPN.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (2.0M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Moore EE, Moore FA. Immediate enteral nutrition following multisystem trauma: a decade perspective. J Am Coll Nutr. 1991 Dec;10(6):633–648. [PubMed]
  • Alexander JW, MacMillan BG, Stinnett JD, Ogle CK, Bozian RC, Fischer JE, Oakes JB, Morris MJ, Krummel R. Beneficial effects of aggressive protein feeding in severely burned children. Ann Surg. 1980;192(4):505–517. [PMC free article] [PubMed]
  • Wilmore DW, Smith RJ, O'Dwyer ST, Jacobs DO, Ziegler TR, Wang XD. The gut: a central organ after surgical stress. Surgery. 1988 Nov;104(5):917–923. [PubMed]
  • Cerra FB. Hypermetabolism, organ failure, and metabolic support. Surgery. 1987 Jan;101(1):1–14. [PubMed]
  • Border JR, Hassett J, LaDuca J, Seibel R, Steinberg S, Mills B, Losi P, Border D. The gut origin septic states in blunt multiple trauma (ISS = 40) in the ICU. Ann Surg. 1987 Oct;206(4):427–448. [PMC free article] [PubMed]
  • Page CP. Edgar J. Poth lecture. The surgeon and gut maintenance. Am J Surg. 1989 Dec;158(6):485–490. [PubMed]
  • Law NW, Ellis H. The effect of parenteral nutrition on the healing of abdominal wall wounds and colonic anastomoses in protein-malnourished rats. Surgery. 1990 Apr;107(4):449–454. [PubMed]
  • Mochizuki H, Trocki O, Dominioni L, Brackett KA, Joffe SN, Alexander JW. Mechanism of prevention of postburn hypermetabolism and catabolism by early enteral feeding. Ann Surg. 1984 Sep;200(3):297–310. [PMC free article] [PubMed]
  • Moore FA, Moore EE, Jones TN, McCroskey BL, Peterson VM. TEN versus TPN following major abdominal trauma--reduced septic morbidity. J Trauma. 1989 Jul;29(7):916–923. [PubMed]
  • Adams S, Dellinger EP, Wertz MJ, Oreskovich MR, Simonowitz D, Johansen K. Enteral versus parenteral nutritional support following laparotomy for trauma: a randomized prospective trial. J Trauma. 1986 Oct;26(10):882–891. [PubMed]
  • Bower RH, Talamini MA, Sax HC, Hamilton F, Fischer JE. Postoperative enteral vs parenteral nutrition. A randomized controlled trial. Arch Surg. 1986 Sep;121(9):1040–1045. [PubMed]
  • Peterson VM, Moore EE, Jones TN, Rundus C, Emmett M, Moore FA, McCroskey BL, Haddix T, Parsons PE. Total enteral nutrition versus total parenteral nutrition after major torso injury: attenuation of hepatic protein reprioritization. Surgery. 1988 Aug;104(2):199–207. [PubMed]
  • Kudsk KA, Carpenter G, Petersen S, Sheldon GF. Effect of enteral and parenteral feeding in malnourished rats with E. coli-hemoglobin adjuvant peritonitis. J Surg Res. 1981 Aug;31(2):105–110. [PubMed]
  • Kudsk KA, Stone JM, Carpenter G, Sheldon GF. Enteral and parenteral feeding influences mortality after hemoglobin-E. coli peritonitis in normal rats. J Trauma. 1983 Jul;23(7):605–609. [PubMed]
  • Saito H, Trocki O, Alexander JW, Kopcha R, Heyd T, Joffe SN. The effect of route of nutrient administration on the nutritional state, catabolic hormone secretion, and gut mucosal integrity after burn injury. JPEN J Parenter Enteral Nutr. 1987 Jan-Feb;11(1):1–7. [PubMed]
  • McArdle AH, Palmason C, Morency I, Brown RA. A rationale for enteral feeding as the preferable route for hyperalimentation. Surgery. 1981 Oct;90(4):616–623. [PubMed]
  • Piccone VA, LeVeen HH, Glass P, Berlyne G, Lundin AP. Prehepatic hyperalimentation. Surgery. 1980 Mar;87(3):263–270. [PubMed]
  • Lickley HL, Track NS, Vranic M, Bury KD. Metabolic responses to enteral and parenteral nutrition. Am J Surg. 1978 Feb;135(2):172–176. [PubMed]
  • Enrione EB, Gelfand MJ, Morgan D, Sperling M, Wagner SC, Popp MB. The effects of rate and route of nutrient intake on protein metabolism. J Surg Res. 1986 Apr;40(4):320–325. [PubMed]
  • Alverdy J, Chi HS, Sheldon GF. The effect of parenteral nutrition on gastrointestinal immunity. The importance of enteral stimulation. Ann Surg. 1985 Dec;202(6):681–684. [PMC free article] [PubMed]
  • Deitch EA, Winterton J, Li M, Berg R. The gut as a portal of entry for bacteremia. Role of protein malnutrition. Ann Surg. 1987 Jun;205(6):681–692. [PMC free article] [PubMed]
  • Souba WW, Smith RJ, Wilmore DW. Glutamine metabolism by the intestinal tract. JPEN J Parenter Enteral Nutr. 1985 Sep-Oct;9(5):608–617. [PubMed]
  • Alverdy JC, Aoys E, Moss GS. Total parenteral nutrition promotes bacterial translocation from the gut. Surgery. 1988 Aug;104(2):185–190. [PubMed]
  • Burke DJ, Alverdy JC, Aoys E, Moss GS. Glutamine-supplemented total parenteral nutrition improves gut immune function. Arch Surg. 1989 Dec;124(12):1396–1399. [PubMed]
  • Meyer J, Yurt RW, Duhaney R, Hesse DG, Tracey KJ, Fong Y, Richardson D, Calvano S, Dineen P, Shires GT, et al. Differential neutrophil activation before and after endotoxin infusion in enterally versus parenterally fed volunteers. Surg Gynecol Obstet. 1988 Dec;167(6):501–509. [PubMed]
  • Cerra FB, Shronts EP, Konstantinides NN, Thoele S, Konstantinides FN, Teasley K, Lysne J. Enteral feeding in sepsis: a prospective, randomized, double-blind trial. Surgery. 1985 Oct;98(4):632–639. [PubMed]
  • Cerra FB, McPherson JP, Konstantinides FN, Konstantinides NN, Teasley KM. Enteral nutrition does not prevent multiple organ failure syndrome (MOFS) after sepsis. Surgery. 1988 Oct;104(4):727–733. [PubMed]
  • Sacks HS, Berrier J, Reitman D, Ancona-Berk VA, Chalmers TC. Meta-analyses of randomized controlled trials. N Engl J Med. 1987 Feb 19;316(8):450–455. [PubMed]
  • L'Abbé KA, Detsky AS, O'Rourke K. Meta-analysis in clinical research. Ann Intern Med. 1987 Aug;107(2):224–233. [PubMed]
  • Border JR, Chenier R, McManamy RH, La Duca J, Seibel R, Birkhahn R, Yu L. Multiple systems organ failure: muscle fuel deficit with visceral protein malnutrition. Surg Clin North Am. 1976 Oct;56(5):1147–1167. [PubMed]
  • Bessey PQ, Jiang ZM, Johnson DJ, Smith RJ, Wilmore DW. Posttraumatic skeletal muscle proteolysis: the role of the hormonal environment. World J Surg. 1989 Jul-Aug;13(4):465–471. [PubMed]
  • Law DK, Dudrick SJ, Abdou NI. Immunocompetence of patients with protein-calorie malnutrition. The effects of nutritional repletion. Ann Intern Med. 1973 Oct;79(4):545–550. [PubMed]
  • Abel RM, Grimes JB, Alonso D, Alonso M, Gay WA., Jr Adverse hemodynamic and ultrastructural changes in dog hearts subjected to protein-calorie malnutrition. Am Heart J. 1979 Jun;97(6):733–744. [PubMed]
  • Arora NS, Rochester DF. Respiratory muscle strength and maximal voluntary ventilation in undernourished patients. Am Rev Respir Dis. 1982 Jul;126(1):5–8. [PubMed]
  • Clarke RM. The time-course of changes in mucosal architecture and epithelial cell production and cell shedding in the small intestine of the rat fed after fasting. J Anat. 1975 Nov;120(Pt 2):321–327. [PMC free article] [PubMed]
  • Drabik MD, Schnure FC, Mok KT, Moldawer LL, Dinarello CA, Blackburn GL, Bistrian BR. Effect of protein depletion and short-term parenteral refeeding on the host response to interleukin 1 administration. J Lab Clin Med. 1987 Apr;109(4):509–516. [PubMed]
  • Horwitz RI. Complexity and contradiction in clinical trial research. Am J Med. 1987 Mar;82(3):498–510. [PubMed]
  • Freiman JA, Chalmers TC, Smith H, Jr, Kuebler RR. The importance of beta, the type II error and sample size in the design and interpretation of the randomized control trial. Survey of 71 "negative" trials. N Engl J Med. 1978 Sep 28;299(13):690–694. [PubMed]
  • Detsky AS, Baker JP, O'Rourke K, Goel V. Perioperative parenteral nutrition: a meta-analysis. Ann Intern Med. 1987 Aug;107(2):195–203. [PubMed]
  • Naylor CD, Detsky AS, O'Rourke K, Fonberg E. Does treatment with essential amino acids and hypertonic glucose improve survival in acute renal failure?: A meta-analysis. Ren Fail. 1987;10(3-4):141–152. [PubMed]
  • Naylor CD, O'Rourke K, Detsky AS, Baker JP. Parenteral nutrition with branched-chain amino acids in hepatic encephalopathy. A meta-analysis. Gastroenterology. 1989 Oct;97(4):1033–1042. [PubMed]
  • Moore FA, Peterson VM, Moore EE, Rundus C, Poggetti R. Inadequate granulopoiesis after major torso trauma: a hematopoietic regulatory paradox. Surgery. 1990 Oct;108(4):667–675. [PubMed]
  • Christou NV, McLean AP, Meakins JL. Host defense in blunt trauma: interrelationships of kinetics of anergy and depressed neutrophil function, nutritional status, and sepsis. J Trauma. 1980 Oct;20(10):833–841. [PubMed]
  • Moore EE, Jones TN. Benefits of immediate jejunostomy feeding after major abdominal trauma--a prospective, randomized study. J Trauma. 1986 Oct;26(10):874–881. [PubMed]
  • Birkhahn RH, Renk CM. Immune response and leucine oxidation in oral and intravenous fed rats. Am J Clin Nutr. 1984 Jan;39(1):45–53. [PubMed]
  • SCHWEINBURG FB, SELIGMAN AM, FINE J. Transmural migration of intestinal bacteria; a study based on the use of radioactive Escherichia coli. N Engl J Med. 1950 May 11;242(19):747–751. [PubMed]
  • Rush BF, Jr, Sori AJ, Murphy TF, Smith S, Flanagan JJ, Jr, Machiedo GW. Endotoxemia and bacteremia during hemorrhagic shock. The link between trauma and sepsis? Ann Surg. 1988 May;207(5):549–554. [PMC free article] [PubMed]
  • Moore FA, Moore EE, Poggetti R, McAnena OJ, Peterson VM, Abernathy CM, Parsons PE. Gut bacterial translocation via the portal vein: a clinical perspective with major torso trauma. J Trauma. 1991 May;31(5):629–638. [PubMed]
  • Wells CL, Maddaus MA, Simmons RL. Proposed mechanisms for the translocation of intestinal bacteria. Rev Infect Dis. 1988 Sep-Oct;10(5):958–979. [PubMed]
  • Marshall JC, Christou NV, Horn R, Meakins JL. The microbiology of multiple organ failure. The proximal gastrointestinal tract as an occult reservoir of pathogens. Arch Surg. 1988 Mar;123(3):309–315. [PubMed]
  • Goris RJ, te Boekhorst TP, Nuytinck JK, Gimbrère JS. Multiple-organ failure. Generalized autodestructive inflammation? Arch Surg. 1985 Oct;120(10):1109–1115. [PubMed]
  • Fry DE, Pearlstein L, Fulton RL, Polk HC., Jr Multiple system organ failure. The role of uncontrolled infection. Arch Surg. 1980 Feb;115(2):136–140. [PubMed]
  • Driks MR, Craven DE, Celli BR, Manning M, Burke RA, Garvin GM, Kunches LM, Farber HW, Wedel SA, McCabe WR. Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. The role of gastric colonization. N Engl J Med. 1987 Nov 26;317(22):1376–1382. [PubMed]
  • Blair P, Rowlands BJ, Lowry K, Webb H, Armstrong P, Smilie J. Selective decontamination of the digestive tract: a stratified, randomized, prospective study in a mixed intensive care unit. Surgery. 1991 Aug;110(2):303–310. [PubMed]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...