Comparisons between intragastric and small intestinal delivery of enteral nutrition in the critically ill: a systematic review and meta-analysis

Deane, Adam M; Dhaliwal, Rupinder; Day, Andrew G.; Ridley, Emma J.; Davies, Andrew R.; Heyland, Daren K.

doi:10.1186/cc12800

Cited by 58 publications

(20 citation statements)

References 47 publications

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“…Several studies in critical care nutrition have not been successful in reaching either target energy or protein delivery (Table 1) [2–4, 7, 40–42]. Notwithstanding that there may be physiological differences in the utilisation of substrates depending on the route and timing of nutrition delivery, strategies to enhance nutrition delivery [62, 63] should be factored into clinical trials where the outcome is dependent upon meeting a target.…”

Section: Methodological Challengesmentioning

confidence: 99%

The role of nutritional support in the physical and functional recovery of critically ill patients: a narrative review

et al. 2017

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The lack of benefit from randomised controlled trials has resulted in significant controversy regarding the role of nutrition during critical illness in terms of long-term recovery and outcome. Although methodological caveats with a failure to adequately appreciate biological mechanisms may explain these disappointing results, it must be acknowledged that nutritional support during early critical illness, when considered alone, may have limited long-term functional impact. This narrative review focuses specifically on recent clinical trials and evaluates the impact of nutrition during critical illness on long-term physical and functional recovery. Specific focus on the trial design and methodological limitations has been considered in detail. Limitations include delivery of caloric and protein targets, patient heterogeneity, short duration of intervention, inappropriate clinical outcomes and a disregard for baseline nutritional status and nutritional intake in the post-ICU period. With survivorship at the forefront of critical care research, it is imperative that nutrition studies carefully consider biological mechanisms and trial design because these factors can strongly influence outcomes, in particular long-term physical and functional outcome. Failure to do so may lead to inconclusive clinical trials and consequent rejection of the potentially beneficial effects of nutrition interventions during critical illness.

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Section: Methodological Challengesmentioning

confidence: 99%

The role of nutritional support in the physical and functional recovery of critically ill patients: a narrative review

et al. 2017

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“…A meta-analysis of 15 RCTs showed that small intestinal feeding compared to gastric feeding improved nutritional intake and reduced the incidence of ICU-acquired pneumonia but did not affect other clinically important outcomes [ 64 ]. However, the indications for small intestinal feeding (when?…”

Section: Remaining Areas Of Uncertaintymentioning

confidence: 99%

The intensive care medicine research agenda in nutrition and metabolism

et al. 2017

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PurposeThe objectives of this review are to summarize the current practices and major recent advances in critical care nutrition and metabolism, review common beliefs that have been contradicted by recent trials, highlight key remaining areas of uncertainty, and suggest recommendations for the top 10 studies/trials to be done in the next 10 years.MethodsRecent literature was reviewed and developments and knowledge gaps were summarized. The panel identified candidate topics for future trials in critical care nutrition and metabolism. Then, members of the panel rated each one of the topics using a grading system (0–4). Potential studies were ranked on the basis of average score.ResultsRecent randomized controlled trials (RCTs) have challenged several concepts, including the notion that energy expenditure must be met universally in all critically ill patients during the acute phase of critical illness, the routine monitoring of gastric residual volume, and the value of immune-modulating nutrition. The optimal protein dose combined with standardized active and passive mobilization during the acute phase and post-acute phase of critical illness were the top ranked studies for the next 10 years. Nutritional assessment, nutritional strategies in critically obese patients, and the effects of continuous versus intermittent enteral nutrition were also among the highest-ranking studies.ConclusionsPriorities for clinical research in the field of nutritional management of critically ill patients were suggested, with the prospect that different nutritional interventions targeted to the appropriate patient population will be examined for their effect on facilitating recovery and improving survival in adequately powered and properly designed studies, probably in conjunction with physical activity.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-017-4711-6) contains supplementary material, which is available to authorized users.

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“…Based on expert opinion, observational studies and small RCTs [3–7], it has been generally recommended to provide full caloric requirement to critically ill patients [8]. To achieve this goal, interventions to augment caloric intake, such as the implementation of protocols [9, 10], prokineteic agents and postpyloric tube placement [11] have been proposed, even though studies have not demonstrated improvement in clinical outcomes. On the contrary, several observational studies observed better outcome with lower enteral caloric intake [12, 13].…”

Section: Introductionmentioning

confidence: 99%

Lower versus higher dose of enteral caloric intake in adult critically ill patients: a systematic review and meta-analysis

et al. 2016

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BackgroundThere is conflicting evidence about the relationship between the dose of enteral caloric intake and survival in critically ill patients. The objective of this systematic review and meta-analysis is to compare the effect of lower versus higher dose of enteral caloric intake in adult critically ill patients on outcome.MethodsWe reviewed MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus from inception through November 2015. We included randomized and quasi-randomized studies in which there was a significant difference in the caloric intake in adult critically ill patients, including trials in which caloric restriction was the primary intervention (caloric restriction trials) and those with other interventions (non-caloric restriction trials). Two reviewers independently extracted data on study characteristics, caloric intake, and outcomes with hospital mortality being the primary outcome.ResultsTwenty-one trials mostly with moderate bias risk were included (2365 patients in the lower caloric intake group and 2352 patients in the higher caloric group). Lower compared with higher caloric intake was not associated with difference in hospital mortality (risk ratio (RR) 0.953; 95 % confidence interval (CI) 0.838–1.083), ICU mortality (RR 0.885; 95 % CI 0.751–1.042), total nosocomial infections (RR 0.982; 95 % CI 0.878–1.077), mechanical ventilation duration, or length of ICU or hospital stay. Blood stream infections (11 trials; RR 0.718; 95 % CI 0.519–0.994) and incident renal replacement therapy (five trials; RR 0.711; 95 % CI 0.545–0.928) were lower with lower caloric intake. The associations between lower compared with higher caloric intake and primary and secondary outcomes, including pneumonia, were not different between caloric restriction and non-caloric restriction trials, except for the hospital stay which was longer with lower caloric intake in the caloric restriction trials.ConclusionsWe found no association between the dose of caloric intake in adult critically ill patients and hospital mortality. Lower caloric intake was associated with lower risk of blood stream infections and incident renal replacement therapy (five trials only). The heterogeneity in the design, feeding route and timing and caloric dose among the included trials could limit our interpretation. Further studies are needed to clarify our findings.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1539-3) contains supplementary material, which is available to authorized users.

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Comparisons between intragastric and small intestinal delivery of enteral nutrition in the critically ill: a systematic review and meta-analysis

Cited by 58 publications

References 47 publications

The role of nutritional support in the physical and functional recovery of critically ill patients: a narrative review

The role of nutritional support in the physical and functional recovery of critically ill patients: a narrative review

The intensive care medicine research agenda in nutrition and metabolism

Lower versus higher dose of enteral caloric intake in adult critically ill patients: a systematic review and meta-analysis

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