Journal of Parenteral and Enteral Nutrition http://pen.sagepub.com/
Calorie Intake of Enteral Nutrition and Clinical Outcomes in Acutely Critically Ill Patients: A Meta-Analysis of Randomized Controlled Trials Eun Young Choi, Dong-Ah Park and Jinkyeong Park JPEN J Parenter Enteral Nutr published online 30 July 2014 DOI: 10.1177/0148607114544322 The online version of this article can be found at: http://pen.sagepub.com/content/early/2014/07/30/0148607114544322
Published by: http://www.sagepublications.com
On behalf of:
The American Society for Parenteral & Enteral Nutrition
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>> OnlineFirst Version of Record - Jul 30, 2014 What is This?
Downloaded from pen.sagepub.com at UNIV TORONTO on August 10, 2014
544322
research-article2014
PENXXX10.1177/0148607114544322Journal of Parenteral and Enteral NutritionChoi et al
Original Communication
Calorie Intake of Enteral Nutrition and Clinical Outcomes in Acutely Critically Ill Patients: A Meta-Analysis of Randomized Controlled Trials
Journal of Parenteral and Enteral Nutrition Volume XX Number X Month 201X 1–10 © 2014 American Society for Parenteral and Enteral Nutrition DOI: 10.1177/0148607114544322 jpen.sagepub.com hosted at online.sagepub.com
Eun Young Choi, MD1; Dong-Ah Park, MPH, PhD2; and Jinkyeong Park, MD3
Abstract Background: The appropriate calorie intake to be provided to critically ill patients via enteral nutrition (EN) remains unclear. We performed a meta-analysis of randomized controlled trials to compare the effect of initial underfeeding and full feeding in acutely critically ill patients. Materials and Methods: We searched the Medline, EMBASE, and Cochrane Central Register of Controlled Trials databases to identify randomized controlled trials that compared underfeeding with full feeding in critically ill patients. The primary outcome was overall mortality. The secondary outcomes included length of hospital stay, length of intensive care unit (ICU) stay, duration of mechanical ventilation, incidence of pneumonia, Clostridium difficile colitis, other infectious complications, and gastrointestinal intolerance. Results: In total, 4 studies were included in this meta-analysis. There was no significant difference in overall mortality between the underfeeding and full-feeding groups (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.74–1.19; I2 = 26.6%; P = .61). Subgroup analysis of the underfeeding subgroup that was fed ≥33.3% of the standard caloric requirement indicated that overall mortality was significantly lower in this underfeeding subgroup than in the full-feeding group (OR, 0.63; 95% CI, 0.40–1.00; I2 = 0%; P = .05). In contrast, no difference in overall mortality was noted between the underfeeding subgroup that was fed 18 years old) critically ill patients in the intensive care unit (ICU) who received EN supplementation through a tube or feeding device, without any aid from PN; (3) intervention: comparison between initial and intentional underfeeding (trophic feeding, hypocaloric feeding, or permissive underfeeding) and a full-feeding strategy, wherein underfeeding was defined as enteral feeding that was initiated at 50% were considered substantial evidence for statistical heterogeneity. Metaanalyses were conducted using the “metan” command24 in Stata SE 13.1 for Mac (StataCorp LP, College Station, TX). The methodological quality of the trials selected was assessed using the criteria described in the Cochrane handbook.23 We prespecified the subgroup analysis according to the level (percentage) of the standard caloric requirement that was achieved. The subgroup cutoff percentage of 33.3% (one underfeeding subgroup was fed ≥33.3% and the other was fed
Calorie Intake of Enteral Nutrition and Clinical Outcomes in Acutely Critically Ill Patients: A Meta-Analysis of Randomized Controlled Trials Eun Young Choi, Dong-Ah Park and Jinkyeong Park JPEN J Parenter Enteral Nutr published online 30 July 2014 DOI: 10.1177/0148607114544322 The online version of this article can be found at: http://pen.sagepub.com/content/early/2014/07/30/0148607114544322
Published by: http://www.sagepublications.com
On behalf of:
The American Society for Parenteral & Enteral Nutrition
Additional services and information for Journal of Parenteral and Enteral Nutrition can be found at: Email Alerts: http://pen.sagepub.com/cgi/alerts Subscriptions: http://pen.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> OnlineFirst Version of Record - Jul 30, 2014 What is This?
Downloaded from pen.sagepub.com at UNIV TORONTO on August 10, 2014
544322
research-article2014
PENXXX10.1177/0148607114544322Journal of Parenteral and Enteral NutritionChoi et al
Original Communication
Calorie Intake of Enteral Nutrition and Clinical Outcomes in Acutely Critically Ill Patients: A Meta-Analysis of Randomized Controlled Trials
Journal of Parenteral and Enteral Nutrition Volume XX Number X Month 201X 1–10 © 2014 American Society for Parenteral and Enteral Nutrition DOI: 10.1177/0148607114544322 jpen.sagepub.com hosted at online.sagepub.com
Eun Young Choi, MD1; Dong-Ah Park, MPH, PhD2; and Jinkyeong Park, MD3
Abstract Background: The appropriate calorie intake to be provided to critically ill patients via enteral nutrition (EN) remains unclear. We performed a meta-analysis of randomized controlled trials to compare the effect of initial underfeeding and full feeding in acutely critically ill patients. Materials and Methods: We searched the Medline, EMBASE, and Cochrane Central Register of Controlled Trials databases to identify randomized controlled trials that compared underfeeding with full feeding in critically ill patients. The primary outcome was overall mortality. The secondary outcomes included length of hospital stay, length of intensive care unit (ICU) stay, duration of mechanical ventilation, incidence of pneumonia, Clostridium difficile colitis, other infectious complications, and gastrointestinal intolerance. Results: In total, 4 studies were included in this meta-analysis. There was no significant difference in overall mortality between the underfeeding and full-feeding groups (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.74–1.19; I2 = 26.6%; P = .61). Subgroup analysis of the underfeeding subgroup that was fed ≥33.3% of the standard caloric requirement indicated that overall mortality was significantly lower in this underfeeding subgroup than in the full-feeding group (OR, 0.63; 95% CI, 0.40–1.00; I2 = 0%; P = .05). In contrast, no difference in overall mortality was noted between the underfeeding subgroup that was fed 18 years old) critically ill patients in the intensive care unit (ICU) who received EN supplementation through a tube or feeding device, without any aid from PN; (3) intervention: comparison between initial and intentional underfeeding (trophic feeding, hypocaloric feeding, or permissive underfeeding) and a full-feeding strategy, wherein underfeeding was defined as enteral feeding that was initiated at 50% were considered substantial evidence for statistical heterogeneity. Metaanalyses were conducted using the “metan” command24 in Stata SE 13.1 for Mac (StataCorp LP, College Station, TX). The methodological quality of the trials selected was assessed using the criteria described in the Cochrane handbook.23 We prespecified the subgroup analysis according to the level (percentage) of the standard caloric requirement that was achieved. The subgroup cutoff percentage of 33.3% (one underfeeding subgroup was fed ≥33.3% and the other was fed
