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All Journal The International Journal of Medical Science and Health Research
Raka Jati Prasetya
Anaesthesiology and Intensive Therapy Consultant, Departement of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of North Sumatera, Indonesia
Dentistry Health Professions Medicine & Pharmacology Nursing Public Health Veterinary

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What is The Effect of Early Enteral Nutrition on Mortality in Critically Ill Patients Receiving Vasopressor Support? : A Systematic Review Landong Sijabat; Raka Jati Prasetya; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 40 No. 2 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/8e740g61

Abstract

Background: The effect of early enteral nutrition (EEN) on mortality in critically ill patients requiring vasopressor support remains debated due to conflicting trial results. Methods: This systematic review synthesized data from 80 studies (2003-2025), including landmark RCTs (NUTRIREA-2, NUTRIREA-3) and large observational cohorts, focusing on mortality, vasopressor dose-response, enteral tolerance, and safety. Results: EEN did not reduce 28-day or 90-day mortality in patients with severe shock (norepinephrine ≥0.3 µg/kg/min) in major RCTs [1,2]. However, a clear dose-response relationship was identified: EEN significantly reduced mortality at low (<0.1 µg/kg/min) and medium (0.1-0.3 µg/kg/min) norepinephrine doses but not at high doses (≥0.3 µg/kg/min) [3]. Benefits were seen in transient shock (resolving <24h) but not persistent shock [4]. High-calorie EEN increased gastrointestinal complications, including vomiting (HR 1.89) and bowel ischemia (HR 3.84) [1], while low-calorie feeding (6 kcal/kg/day) reduced these risks [2]. Discussion: The effect of EEN on mortality is highly context-dependent. The lack of benefit in trials like NUTRIREA-2/3 is explained by enrollment of patients on high-dose vasopressors and use of immediate full-dose feeding—a strategy now considered harmful. Observational benefits likely reflect hemodynamic stability at feeding initiation. A safe approach includes starting trophic EEN (6-15 kcal/kg/day) after initial resuscitation when vasopressor doses are stable and ≤0.3 µg/kg/min, with gradual advancement. Conclusion: EEN does not reduce mortality in patients on high-dose vasopressors (≥0.3 µg/kg/min norepinephrine) but may improve survival in those on low-to-moderate doses with transient shock. Clinical practice should shift from rigid timing to hemodynamic-guided, gradual feeding.
What is The Effect of Early Surgical Stabilization of Rib Fractures Compared to Conservative Management on Pain Control and Pulmonary Function in ICU Patients? : A Systematic Review Landong Sijabat; Raka Jati Prasetya; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 40 No. 2 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/zb5qvt71

Abstract

Introduction: Rib fractures, especially flail chest and multiple displaced fractures, cause severe pain and respiratory dysfunction, often requiring ICU admission. The optimal management—early surgical stabilization (SSRF) versus conservative treatment—remains debated. Methods: This systematic review synthesized 80 studies (RCTs, etc) comparing early SSRF (≤72 hours) to conservative management in adult ICU patients with rib fractures. Outcomes focused on pain control, pulmonary function, and clinical endpoints. Results: Early SSRF significantly reduced pain scores at 2 weeks (NPS 2.9 vs. 4.5, p<0.01) [1] and lowered opioid requirements (155 vs. 246 morphine milliequivalents, p<0.001) [3]. Pulmonary benefits included shorter mechanical ventilation (mean difference -4.52 days) [4], reduced pneumonia (RR 0.57) [11], and fewer tracheostomies (OR 0.25) [4]. ICU stay decreased by ~4 days [8], and mortality improved (OR 0.3) [8]. Early intervention (≤72h) was superior to delayed surgery [21,25]. Benefits were most pronounced in flail chest, elderly, and mechanically ventilated patients [13,14,43]. Discussion: SSRF provides rapid pain relief, improves respiratory mechanics, and reduces complications, but outcomes depend on timing, patient selection, and injury pattern. Heterogeneity exists, with non-flail fractures showing less consistent benefit [19]. Conclusion: Early SSRF (within 72 hours) significantly improves pain, pulmonary function, and survival in high-risk ICU patients with severe rib fractures. Delayed surgery loses advantage. Future RCTs should standardize timing and subgroups.
Co-Authors Landong Sijabat Mutia Juliana