S762 Enteral Nutrition Alone as a Stress Ulcer Prophylaxis in Mechanically Ventilated Patients: A Meta-Analysis of Randomized Controlled Trials

Introduction: Some early reports found that early enteral nutrition (EN) may be as effective as pharmacologic stress ulcer prophylactic (SUP) agents in preventing gastrointestinal (GI) bleeding in mechanically ventilated patients. We conducted a meta-analysis of randomized control trials (RCTs) to compare outcomes of EN plus pharmacological SUP vs EN alone in mechanically ventilated patients. Methods: Several databases were reviewed to identify studies com comparing EN plus pharmacological SUP and EN alone in preventing GI bleeding in mechanically ventilated patients, from inception to November 01, 2024. The databases searched included PubMed, Web of Science Core Collection, Embase, and the Cochrane Database of Systematic Reviews. Our outcomes of interest were GI bleeding, overall mortality, Clostridioides difficile infection (CDI), and ventilator-associated pneumonia (VAP). We calculated risk ratios (RRs) with 95% confidence intervals (CIs) for all the outcomes. Data was analyzed using random effect model. Heterogeneity was assessed using the I2 statistic. Results: Five studies comprising 498 patients (EN plus pharmacological SUP 251 patients and EN alone 247 patients) met the inclusion criteria. We only included patients requiring mechanical ventilation. We found no significant difference in rate of GI bleeding between groups, RR (95% CI): 0.93 (0.24, 3.70), P = 0.92. There was no significant difference in VAP, RR (95% CI): 1.38 (0.70, 2.72), P = 0.36, overall mortality, RR (95% CI): 1.29 (0.91, 1.82), P = 0.16, and C. diff infection rate, RR (95% CI): 0.70 (0.07, 6.72), P = 0.76 between groups. Conclusion: Our meta-analysis found no significant difference in outcomes in mechanically ventilated patients who received EN plus pharmacological stress ulcer prophylaxis vs EN alone. Our findings suggest initiating early enteral nutrition in mechanically ventilated patients.