Effectiveness of non‐pharmacological interventions to prevent enteral nutrition intolerance in ICU patients: A network meta‐analysis

Abstract Background Enteral nutrition is beneficial for improving the clinical outcomes of intensive care unit patients. However, enteral nutrition intolerance is a common complication in intensive care unit patients undergoing enteral nutrition. Aims We aimed to assess the effectiveness of non‐pharmacological interventions in preventing enteral nutrition intolerance in intensive care unit patients and to identify the optimal non‐pharmacological interventions. Study Design Seven databases were searched to obtain randomized controlled trials involving non‐pharmacological interventions to prevent enteral nutrition intolerance in intensive care unit patients. Network meta‐analysis was performed using Stata18.0 software, and the integrated data were investigated with odds ratio ( OR ) and 95% confidence interval (95% CI ). Results A total of 16 randomized controlled trials involving 10 non‐pharmacological interventions and 1765 intensive care unit patients were included. Compared with routine enteral nutrition care, network meta‐analysis showed that bundled care [ OR = 0.93, 95% CI (0.32–1.53)] ( p = .003), intra‐abdominal pressure monitoring [ OR = 1.68, 95% CI (1.19–2.16)] ( p < .001), acupuncture [ OR = 2.69, 95% CI (1.64–3.73)] ( p < .001), pectin‐added intermittent enteral nutrition [ OR = 1.13, 95% CI (0.48–1.77)] ( p = .001), multidisciplinary nutritional treatment model [ OR = 1.98, 95% CI (0.87–3.10)] ( p < .001), abdominal massage [ OR = 2.42, 95% CI (1.50–3.34)] ( p < .001) and intermittent feeding with semisolid nutrients [ OR = 2.08, 95% CI (0.19–3.97)] ( p = .031) were effective in preventing enteral nutrition intolerance in intensive care unit patients. The ranking probabilities of the interventions indicated that acupuncture (89.4%) was the optimal non‐pharmacological intervention for preventing enteral nutrition intolerance in intensive care unit patients, followed by abdominal massage (83.4%). Conclusions Acupuncture and abdominal massage are recommended to prevent enteral nutrition intolerance in intensive care unit patients. Moreover, more high‐quality trials are needed to investigate the reliability of evidence levels for different non‐pharmacological interventions. Relevance to Clinical Practice This study provided evidence for intensive care nurses that acupuncture is the optimal intervention to improve enteral nutrition intolerance in intensive care unit patients among the 10 interventions. However, unique clinical circumstances should be considered. Therefore, we recommend that intensive care nurses also use abdominal massage when acupuncture is not available.