Effect of hypocaloric versus standard enteral feeding on clinical outcomes in critically ill adults – A meta-analysis of randomized controlled trials with trial sequential analysis

Zhou, Xiaoyang; Fang, Hanyuan; Hu, Caibao; Xu, Jun; Wang, H.; Pan, Junxiao; Sha, Yingying; Xu, Zhaojun

doi:10.1016/j.medin.2019.10.003

Cited by 2 publications

(2 citation statements)

References 40 publications

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“…Our findings are not entirely consistent with those of previous studies. A meta-analysis conducted by Zhou et al concluded that there were no benefits in terms of reducing short-term mortality or the duration of mechanical ventilation [ 38 ]. A meta-analysis conducted by Pertzov et al concluded that isocaloric nutrition was associated with a lower 28-day mortality, and no significant difference was observed in ICU mortality between the two groups [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of permissive underfeeding for critically ill patients: an updated systematic review and trial sequential meta-analysis

Yue,

Peng,

Zeng

et al. 2024

j intensive care

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Background Our previous study in 2011 concluded that permissive underfeeding may improve outcomes in patients receiving parenteral nutrition therapy. This conclusion was tentative, given the small sample size. We conducted the present systematic review and trial sequential meta-analysis to update the status of permissive underfeeding in patients who were admitted to the intensive care unit (ICU). Methods Seven databases were searched: PubMed, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature Database, and Cochrane Library. Randomized controlled trials (RCTs) were included. The Revised Cochrane risk-of-bias tool (ROB 2) was used to assess the risk of bias in the enrolled trials. RevMan software was used for data synthesis. Trial sequential analyses (TSA) of overall and ICU mortalities were performed. Results Twenty-three RCTs involving 11,444 critically ill patients were included. There were no significant differences in overall mortality, hospital mortality, length of hospital stays, and incidence of overall infection. Compared with the control group, permissive underfeeding significantly reduced ICU mortality (risk ratio [RR] = 0.90; 95% confidence interval [CI], [0.81, 0.99]; P = 0.02; I2 = 0%), and the incidence of gastrointestinal adverse events decreased (RR = 0.79; 95% CI, [0.69, 0.90]; P = 0.0003; I2 = 56%). Furthermore, mechanical ventilation duration was reduced (mean difference (MD) = − 1.85 days; 95% CI, [− 3.44, − 0.27]; P = 0.02; I2 = 0%). Conclusions Permissive underfeeding may reduce ICU mortality in critically ill patients and help to shorten mechanical ventilation duration, but the overall mortality is not improved. Owing to the sample size and patient heterogeneity, the conclusions still need to be verified by well-designed, large-scale RCTs. Trial Registration The protocol for our meta-analysis and systematic review was registered and recorded in PROSPERO (registration no. CRD42023451308). Registered 14 August 2023

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Section: Discussionmentioning

confidence: 99%

Efficacy of permissive underfeeding for critically ill patients: an updated systematic review and trial sequential meta-analysis

Yue,

Peng,

Zeng

et al. 2024

j intensive care

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“…Conversely, the majority of RCTs did not confirm these observations. A recent systematic review by Zhou et al [22 ▪ ] observed no effect of hypocaloric feeding in the early phase of critical illness, with matched protein intake levels, on mortality and ICU or hospital length of stay. However, this systematic review included studies using predictive formulas and IC-derived measurements to calculate EE.…”

Section: Prevention Of Overfeeding In the Early Phasementioning

confidence: 99%

Current insights in ICU nutrition: tailored nutrition

Hermans

Laarhuis²,

Kouw

et al. 2023

Current Opinion in Critical Care

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Purpose of reviewTo summarize recent research on critical care nutrition focusing on the optimal composition, timing, and monitoring of enteral feeding strategies for (post)-ICU patients. We provide new insights on energy and protein recommendations, feeding intolerance, and describe nutritional practices for coronavirus disease 2019 ICU patients.Recent findingsThe use of indirect calorimetry to establish individual energy requirements for ICU patients is considered the gold standard. The limited research on optimal feeding targets in the early phase of critical illness suggests avoiding overfeeding. Protein provision based upon the absolute lean body mass is rational. Therefore, body composition measurements should be considered. Body impedance analysis and muscle ultrasound seem reliable, affordable, and accessible methods to assess body composition at the bedside. There is inadequate evidence to change our practice of continuous enteral feeding into intermittent feeding. Finally, severe acute respiratory syndrome coronavirus 2 patients are prone to underfeeding due to hypermetabolism and should be closely monitored.SummaryNutritional therapy should be adapted to the patient's characteristics, diagnosis, and state of metabolism during ICU stay and convalescence. A personalized nutrition plan may prevent harmful over- or underfeeding and attenuate muscle loss. Despite novel insights, more research is warranted into tailored nutrition strategies during critical illness and convalescence.

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Effect of hypocaloric versus standard enteral feeding on clinical outcomes in critically ill adults – A meta-analysis of randomized controlled trials with trial sequential analysis

Cited by 2 publications

References 40 publications

Efficacy of permissive underfeeding for critically ill patients: an updated systematic review and trial sequential meta-analysis

Efficacy of permissive underfeeding for critically ill patients: an updated systematic review and trial sequential meta-analysis

Current insights in ICU nutrition: tailored nutrition

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