What are the benefits and harms of delayed enteral feeding in acute spinal cord injury patients in critical care units? A systematic review.

Abstract

Background: Spinal cord injury (SCI) is a devastating condition with a high burden of morbidity and mortality. National guidelines state that patients should not receive enteral feeding for 48 hours after inury, which may be detrimental if a patient experiences a hypercatabolic response to polytrauma. We conducted a systematic review of the benefits and harms of delayed enteral feeding in this population.

Methods: We searched MEDLINE, EMBASE and Cochrane CENTRAL for studies which had a time parameter as part of their evaluation of feeding in the acute phase of spinal cord injury in a critical care setting. Required outcomes for inclusion were neurological improvement, neurological complications, time spent in an ICU, time to ICU discharge, incidence of secondary complications, other adverse effects and mortality. Risk of bias was assessed with the Downs and Black checklist.

Results: Four studies met the inclusion criteria. There was no high-quality evidence of worsened outcomes with earlier feeding compared to delayed enteral feeding. One study demonstrated that patients fed before 24 h in conjunction with a broader bundle of care had improved neurological outcomes compared to previous non-standardised practice. There was no evidence of difference in frequency of infections or mortality in early or late feeding groups.

Conclusions: We find no clear evidence of increased risk of harm from earlier enteral feeding strategies, nor clear evidence of benefit of earlier feeding as an isolated intervention.