Association between enteral nutrition and the incidence of pneumonia in critical care adults: A literature review

https://doi.org/10.53730/ijhs.v9n1.15531

Authors

  • Ahmed O. Alenazi Department of Pharmaceutical Services, Imam Abdulrahman Bin Faisal Hospital, King Abdulaziz Medical City, Minister of National Guard Health Affair, Dammam, Saudi Arabia & King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
  • Mashael Alharbi Department of Clinical Nutrition, Imam Abdulrahman Bin Faisal Hospital, King Abdulaziz Medical City, National Guard Health Affair, Dammam, Saudi Arabia & King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
  • Afnan A. Alsaab Department of Clinical Nutrition, Imam Abdulrahman Bin Faisal Hospital, King Abdulaziz Medical City, National Guard Health Affair, Dammam, Saudi Arabia & King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
  • Metrek A. Aldossary King Fahad Military Medical Complex- Dahran, Saudi Arabia
  • Salem T. Khrnoob King Fahad Military Medical Complex- Dahran, Saudi Arabia
  • Faisal Alzoabi King Fahad Military Medical Complex- Dahran, Saudi Arabia
  • Saleh M. Alhuwaiji King Fahad Military Medical Complex- Dahran, Saudi Arabia
  • Abdulhadi Alzahrani King Fahad Military Medical Complex- Dahran, Saudi Arabia
  • Amro A. Alamro AL Qassim Primary Health Care, National Guard Health Affair, Qassim, Saudi Arabia
  • Sultan L. Alenazi AL Qassim Primary Health Care, National Guard Health Affair, Qassim, Saudi Arabia
  • Waad Alharbi Prince Mohammed Bin Abdulaziz Hospital, National Guard Health Affair, Medina, Saudi Arabia
  • Shouq Alahmadi Prince Mohammed Bin Abdulaziz Hospital, National Guard Health Affair, Medina, Saudi Arabia
  • Ghada A. Aloufi Prince Sultan Military Medical City-Riyadh, Saudi Arabia

Keywords:

adults, aspiration, association, critical care, enteral nutrition, feeding, pneumonia

Abstract

Background: To investigate the association between enteral feeding and the risk of pneumonia in critical care adult patients. Methods: An updated literature review of studies discussing between 2016 and 2023. CINAHL, Cochrane, Embase, PubMed, Scopus, and Web of Science databases were used to explore studies regarding our subject, and the association between enteral feeding and the risk of pneumonia in critical care adults. Results: Enteral nutrition (EN) has been linked to a significant reduction in pneumonia, as well as shorter ICU or hospital stays, and decreased mechanical ventilation duration in numerous studies. Conversely, pneumonia risk and other infections, as well as the fatality rate, have been found to increase with EN. Early initiation of EN within 48 hours, along with a low-calorie diet containing (< 600 Kcal/day) demonstrated a notable decrease in the occurrence of Ventilator-Associated Pneumonia (VAP) when contrasted with delayed EN and a high-calorie diet. EN was associated with a marked decrease in adverse events including aspiration pneumonia, emesis, and the escalation of respiratory support. Conclusion: EN is safe and effective in critically ill patients. Future research should investigate the monitoring of larger sample sizes to ascertain the most effective feeding methods in the intensive care unit.

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References

Anker, S. D., John, M., Pedersen, P. U., Raguso, C., Cicoira, M., Dardai, E., ... & Vogelmeier, C. (2006). ESPEN guidelines on enteral nutrition: cardiology and pulmonology. Clinical Nutrition, 25(2), 311-318. https://doi.org/10.1016/j.clnu.2006.01.017 DOI: https://doi.org/10.1016/j.clnu.2006.01.017

Al‐Omran, M., AlBalawi, Z. H., Tashkandi, M. F., & Al‐Ansary, L. A. (2010). Enteral versus parenteral nutrition for acute pancreatitis. Cochrane database of systematic reviews, (1). DOI: https://doi.org/10.1002/14651858.CD002837.pub2

Capurso, G., Zerboni, G., Signoretti, M., Valente, R., Stigliano, S., Piciucchi, M., & Delle Fave, G. (2012). Role of the gut barrier in acute pancreatitis. Journal of clinical gastroenterology, 46, S46-S51. DOI: https://doi.org/10.1097/MCG.0b013e3182652096

Cintra, M. T. G., De Rezende, N. A., De Moraes, E. N., Cunha, L. C. M., & da Gama Torres, H. O. (2014). A comparison of survival, pneumonia, and hospitalization in patients with advanced dementia and dysphagia receiving either oral or enteral nutrition. The journal of nutrition, health & aging, 18, 894-899. DOI: https://doi.org/10.1007/s12603-014-0487-3

Compher, C., Bingham, A. L., McCall, M., Patel, J., Rice, T. W., Braunschweig, C., & McKeever, L. (2022). Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. Journal of Parenteral and Enteral Nutrition, 46(1), 12-41. DOI: https://doi.org/10.1002/jpen.2267

Correia, M. I. T., Perman, M. I., & Waitzberg, D. L. (2017). Hospital malnutrition in Latin America: A systematic review. Clinical nutrition, 36(4), 958-967. https://doi.org/10.1016/j.clnu.2016.06.025 DOI: https://doi.org/10.1016/j.clnu.2016.06.025

Cunha, B. A. (2001). Pneumonia in the elderly. Clinical microbiology and infection, 7(11), 581-588. https://doi.org/10.1046/j.1198-743x.2001.00328.x DOI: https://doi.org/10.1046/j.1198-743x.2001.00328.x

Gaitanidis, A., Breen, K., Mendoza, A., Fawley, J., Lee, J., Parks, J., ... & Fagenholz, P. J. (2022). Enteral nutrition is associated with high rates of pneumonia in intensive care unit (ICU) patients with acute pancreatitis. Journal of Critical Care, 69, 154012. https://doi.org/10.1016/j.jcrc.2022.154012 DOI: https://doi.org/10.1016/j.jcrc.2022.154012

Guidelines, A. A. P. (2013). IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology, 13(4), e1-e15. https://doi.org/10.1016/j.pan.2013.07.063 DOI: https://doi.org/10.1016/j.pan.2013.07.063

Hamilton, L. A., Darby, S. H., & Rowe, A. S. (2021). A retrospective cohort analysis of the use of enteral nutrition plus pharmacologic prophylaxis or enteral nutrition alone. Hospital Pharmacy, 56(6), 729-736. DOI: https://doi.org/10.1177/0018578720954159

Harvey, S. E., Parrott, F., Harrison, D. A., Bear, D. E., Segaran, E., Beale, R., ... & Rowan, K. M. (2014). Trial of the route of early nutritional support in critically ill adults. New England Journal of Medicine, 371(18), 1673-1684. DOI: https://doi.org/10.1056/NEJMoa1409860

Heyland, D. K., Dhaliwal, R., Drover, J. W., Gramlich, L., & Dodek, P. (2003). Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. Journal of Parenteral and Enteral nutrition, 27(5), 355-373. DOI: https://doi.org/10.1177/0148607103027005355

Hilker, R., Poetter, C., Findeisen, N., Sobesky, J., Jacobs, A., Neveling, M., & Heiss, W. D. (2003). Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine. Stroke, 34(4), 975-981. DOI: https://doi.org/10.1161/01.STR.0000063373.70993.CD

Hiura, G., Lebwohl, B., & Seres, D. S. (2020). Malnutrition diagnosis in critically ill patients using 2012 Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition standardized diagnostic characteristics is associated with longer hospital and intensive care unit length of stay and increased in‐hospital mortality. Journal of Parenteral and Enteral Nutrition, 44(2), 256-264. DOI: https://doi.org/10.1002/jpen.1599

Hsieh, P. H., Su, H. Y., Lin, C. Y., Kang, Y. N., & Chang, C. C. (2019). Infection rate among nutritional therapies for acute pancreatitis: A systematic review with network meta-analysis of randomized controlled trials. PloS one, 14(7), e0219151. DOI: https://doi.org/10.1371/journal.pone.0219151

Klompas, M., Branson, R., Cawcutt, K., Crist, M., Eichenwald, E. C., Greene, L. R., ... & Berenholtz, S. M. (2022). Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infection Control & Hospital Epidemiology, 43(6), 687-713. DOI: https://doi.org/10.1017/ice.2022.88

Kreymann, K. G., Berger, M. M., Deutz, N. E., Hiesmayr, M., Jolliet, P., Kazandjiev, G., ... & Spies, C. E. S. P. E. N. (2006). ESPEN guidelines on enteral nutrition: intensive care. Clinical nutrition, 25(2), 210-223. https://doi.org/10.1016/j.clnu.2006.01.021 DOI: https://doi.org/10.1016/j.clnu.2006.01.021

Lakananurak, N., & Gramlich, L. (2020). Nutrition management in acute pancreatitis: Clinical practice consideration. World journal of clinical cases, 8(9), 1561. DOI: https://doi.org/10.12998/wjcc.v8.i9.1561

Lee, J. C., Williams, G. W., Kozar, R. A., Kao, L. S., Mueck, K. M., Emerald, A. D., ... & Moore, L. J. (2018). Multitargeted feeding strategies improve nutrition outcome and are associated with reduced pneumonia in a level 1 trauma intensive care unit. Journal of Parenteral and Enteral Nutrition, 42(3), 529-537. DOI: https://doi.org/10.1177/0148607117699561

Lewis, S. R., Butler, A. R., Alderson, P., & Smith, A. F. (2016). Enteral versus parenteral nutrition for adults in the intensive care unit. Cochrane Database of Systematic Reviews, 7. DOI: https://doi.org/10.1002/14651858.CD012276

Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P., ... & Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Annals of internal medicine, 151(4), W-65. DOI: https://doi.org/10.7326/0003-4819-151-4-200908180-00136

Liu, Y., Zhao, W., Chen, W., Shen, X., Fu, R., Zhao, Y., & Liu, H. (2020). Effects of early enteral nutrition on immune function and prognosis of patients with sepsis on mechanical ventilation. Journal of intensive care medicine, 35(10), 1053-1061. DOI: https://doi.org/10.1177/0885066618809893

Mizuma, A., Netsu, S., Sakamoto, M., Yutani, S., Nagata, E., & Takizawa, S. (2021). Effect of early enteral nutrition on critical care outcomes in patients with acute ischemic stroke. Journal of International Medical Research, 49(11), 03000605211055829. DOI: https://doi.org/10.1177/03000605211055829

Moore, F. A., Feliciano, D. V., Andrassy, R. J., Mcardle, A. H., Booth, F. V. M., Morgenstein-Wagner, T. B., ... & Moore, E. E. (1992). Early enteral feeding, compared with parenteral, reduces postoperative septic complications the results of a meta-analysis. Annals of surgery, 216(2), 172-183. DOI: https://doi.org/10.1097/00000658-199208000-00008

Nakayama, H., Nishimoto, Y., Hotta, K., & Sato, Y. (2020). Safety of early enteral nutrition for cardiac medical critically ill patients―A retrospective observational study―. Circulation Reports, 2(10), 560-564. DOI: https://doi.org/10.1253/circrep.CR-20-0033

Needham, D. M., Scales, D. C., Laupacis, A., & Pronovost, P. J. (2005). A systematic review of the Charlson comorbidity index using Canadian administrative databases: a perspective on risk adjustment in critical care research. Journal of critical care, 20(1), 12-19. https://doi.org/10.1016/j.jcrc.2004.09.007 DOI: https://doi.org/10.1016/j.jcrc.2004.09.007

Nolan, J. P., Neumar, R. W., Adrie, C., Aibiki, M., Berg, R. A., Böttiger, B. W., ... & Hoek, T. V. (2008). Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication: a scientific statement from the International liaison committee on resuscitation; the American heart Association emergency cardiovascular care Committee; the Council on cardiovascular surgery and anesthesia; the Council on cardiopulmonary, perioperative, and critical care; the Council on clinical cardiology; the Council on stroke. Resuscitation, 79(3), 350-379. https://doi.org/10.1016/j.resuscitation.2008.09.017 DOI: https://doi.org/10.1016/j.resuscitation.2008.09.017

O’Keefe, S. J., Broderick, T., Turner, M., Stevens, S., & O’Keefe, J. S. (2003). Nutrition in the management of necrotizing pancreatitis. Clinical Gastroenterology and Hepatology, 1(4), 315-321. https://doi.org/10.1016/S1542-3565(03)00137-X DOI: https://doi.org/10.1016/S1542-3565(03)00137-X

Pash, E. (2018). Enteral nutrition: options for short‐term access. Nutrition in Clinical Practice, 33(2), 170-176. DOI: https://doi.org/10.1002/ncp.10007

Patel, J. J., Kozeniecki, M., Biesboer, A., Peppard, W., Ray, A. S., Thomas, S., ... & Kumar, G. (2016). Early trophic enteral nutrition is associated with improved outcomes in mechanically ventilated patients with septic shock: a retrospective review. Journal of intensive care medicine, 31(7), 471-477. DOI: https://doi.org/10.1177/0885066614554887

Reignier, J., Boisramé-Helms, J., Brisard, L., Lascarrou, J. B., Hssain, A. A., Anguel, N., ... & Bodet-Contentin, L. (2018). Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). The Lancet, 391(10116), 133-143. DOI: https://doi.org/10.1016/S0140-6736(17)32146-3

Savio, R. D., Parasuraman, R., Lovesly, D., Shankar, B., Ranganathan, L., Ramakrishnan, N., & Venkataraman, R. (2021). Feasibility, tolerance and effectiveness of enteral feeding in critically ill patients in prone position. Journal of the Intensive Care Society, 22(1), 41-46. DOI: https://doi.org/10.1177/1751143719900100

Segaran, E., Barker, I., & Hartle, A. (2016). Optimising enteral nutrition in critically ill patients by reducing fasting times. Journal of the Intensive Care Society, 17(1), 38-43. DOI: https://doi.org/10.1177/1751143715599410

Singer, P., Blaser, A. R., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., ... & Bischoff, S. C. (2019). ESPEN guideline on clinical nutrition in the intensive care unit. Clinical nutrition, 38(1), 48-79. https://doi.org/10.1016/j.clnu.2018.08.037 DOI: https://doi.org/10.1016/j.clnu.2018.08.037

Su, S., Sun, R., Liu, R., & Xu, Z. (2018). Effect of enteral nutrition time on pH value of gastric juice and ventilator-associated pneumonia in critically ill patient. Zhonghua wei Zhong Bing ji jiu yi xue, 30(8), 768-770.

Vashi, P. G., Virginkar, N., Popiel, B., Edwin, P., & Gupta, D. (2017). Incidence of and factors associated with catheter-related bloodstream infection in patients with advanced solid tumors on home parenteral nutrition managed using a standardized catheter care protocol. BMC infectious diseases, 17, 1-9. DOI: https://doi.org/10.1186/s12879-017-2469-7

Worthington, P., Balint, J., Bechtold, M., Bingham, A., Chan, L. N., Durfee, S., ... & Holcombe, B. (2017). When is parenteral nutrition appropriate?. Journal of Parenteral and Enteral Nutrition, 41(3), 324-377. DOI: https://doi.org/10.1177/0148607117695251

Wu, L. M., Sankaran, S. J., Plank, L. D., Windsor, J. A., & Petrov, M. S. (2014). Meta-analysis of gut barrier dysfunction in patients with acute pancreatitis. Journal of British Surgery, 101(13), 1644-1656. DOI: https://doi.org/10.1002/bjs.9665

Yi, F., Ge, L., Zhao, J., Lei, Y., Zhou, F., Chen, Z., ... & Xia, B. (2012). Meta-analysis: total parenteral nutrition versus total enteral nutrition in predicted severe acute pancreatitis. Internal medicine, 51(6), 523-530. DOI: https://doi.org/10.2169/internalmedicine.51.6685

Published

07-02-2025

How to Cite

Alenazi, A. O., Alharbi, M., Alsaab, A. A., Aldossary, M. A., Khrnoob, S. T., Alzoabi, F., Alhuwaiji, S. M., Alzahrani, A., Alamro, A. A., Alenazi, S. L., Alharbi, W., Alahmadi, S., & Aloufi, G. A. (2025). Association between enteral nutrition and the incidence of pneumonia in critical care adults: A literature review. International Journal of Health Sciences, 9(1), 163–173. https://doi.org/10.53730/ijhs.v9n1.15531

Issue

Vol. 9 No. 1 (2025): April

Section

Peer Review Articles
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