Effects of early enteral nutrition on immune function of severe acute pancreatitis patients

Sun, Jianfang; Mu, Xinwei; Li, Weiqin; Tong, Zhihui; Li, Jing

doi:10.3748/wjg.v19.i6.917

Cited by 124 publications

(101 citation statements)

References 25 publications

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“…We identified a total of 10 trials with 2888 patients that were conducted in heterogeneous critically ill and surgical patients, trauma and traumatic brain injury, and those with severe acute pancreatitis [550][551][552][553][554][555][556][557][558][559]. No evidence showed that early parenteral nutrition reduced mortality (RR 0.97; 95% CI 0.87-1.08; n = 2745) or infection risk (RR 1.52; 95% CI 0.88-2.62; n = 2526), but ICU LOS was increased (MD, 0.90; 95% CI 0.38-1.42; n = 46).…”

Section: T Nutritionmentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

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Section: T Nutritionmentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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“…Seven out of seven articles contained analyzable data on mortal [16][17][18][19][20][21][22] Risk differences and CI were calculated in each article to analyze the effects of EN compared to the NPO nutrition. The calculated average risk difference (RD) was −0.050 (lower limit (LI): −0.134; upper limit (UI): 0.035; p-value: 0.249) (Figure 1).…”

Section: Severe Acute Pancreatitis (Sap) Groupmentioning

confidence: 99%

“…Thirty-three articles (21 articles containing patients suffering from SAP as well as 12 articles with MAP patients) were selected. They contained two nonrandomized and 31 randomized controlled clinical trials (Table 2) [16][17][18][19][20][21][22][23][24][25][26][27]29,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50]. Finally, statistical analyses were performed on data from articles where both EN and NPO groups were presented, the trial was randomized, and the relevant data were available.…”

Section: Inclusions and Exclusionsmentioning

confidence: 99%

Meta-analysis of early nutrition: the benefits of enteral feeding compared to a nil per os diet not only in severe, but also in mild and moderate acute pancreatitis

2017

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Abstract:The recently published guidelines for acute pancreatitis (AP) suggest that enteral nutrition (EN) should be the primary therapy in patients suffering from severe acute pancreatitis (SAP); however, none of the guidelines have recommendations on mild and moderate AP (MAP). A meta-analysis was performed using the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). The following PICO (problem, intervention, comparison, outcome) was applied: P: nutrition in AP; I: enteral nutrition (EN); C: nil per os diet (NPO); and O: outcome. There were 717 articles found in Embase, 831 in PubMed, and 10 in the Cochrane database. Altogether, seven SAP and six MAP articles were suitable for analyses. In SAP, forest plots were used to illustrate three primary endpoints (mortality, multiorgan failure, and intervention). In MAP, 14 additional secondary endpoints were analyzed (such as CRP (C-reactive protein), WCC (white cell count), complications, etc.). After pooling the data, the Mann-Whitney U test was used to detect significant differences. Funnel plots were created for testing heterogeneity. All of the primary endpoints investigated showed that EN is beneficial vs. NPO in SAP. In MAP, all of the six articles found merit in EN. Analyses of the primary endpoints did not show significant differences between the groups; however, analyzing the 17 endpoints together showed a significant difference in favor of EN vs. NPO. EN is beneficial compared to a nil per os diet not only in severe, but also in mild and moderate AP.

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“…Th1 cell release TNF-alpha. A study by Pietruczuk showed that in acute phase, Th1 cell was suppressed so that the more active 8 In acute pancreatitis with sepsis, 80% among patients was in hypermetabolic condition. Nutritional requirement was increase because of increase resting energy espenditure (REE) and protein breakdown.…”

Section: Acute Pancreatitis Pathophysiologymentioning

confidence: 99%

“…Oxygen consumption increase by 20-30% cause the need of more energy supply or reduce perfusion to several vital organs. Both was caused by hypovolemia and reduce 8 In acute pancreatitis, capillary permeability will increase and lead to pancreatic enzyme leakage. This will trigger local hydrolysis process of triglyceride that comes from cylomicrone.…”

Section: Acute Pancreatitis Pathophysiologymentioning

confidence: 99%

Nutritional Management in Acute Pancreatitis

Listya

Syam

2016

InaJGHE

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Effects of early enteral nutrition on immune function of severe acute pancreatitis patients

Abstract: EEN moderates the excessive immune response during the early stage of SAP without leading to subsequent immunosuppression. EEN can improve the clinical outcome, but not decrease the hospital mortality of SAP patients.

Cited by 124 publications

References 25 publications

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Meta-analysis of early nutrition: the benefits of enteral feeding compared to a nil per os diet not only in severe, but also in mild and moderate acute pancreatitis

Nutritional Management in Acute Pancreatitis

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