Journal Article

Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle

Simpson, Fiona, Doig, Gordon Stuart

2005

Overview

Controversy surrounds the use of parenteral nutrition in critical illness. Previous overviews used composite scales to identify high-quality trials, which may mask important differences in true methodological quality. Using a component-based approach this meta-analysis investigated the effect of trial quality on overall conclusions reached when standard enteral nutrition is compared to standard parenteral nutrition in critically ill patients. An extensive literature search was undertaken to identify all eligible trials. We retrieved 465 publications, and 11 qualified for inclusion. Nine trials presented complete follow-up, allowing the conduct of an intention to treat analysis. Aggregation revealed a mortality benefit in favour of parenteral nutrition, with no heterogeneity. A priori specified subgroup analysis demonstrated the presence of a potentially important treatment-subgroup interaction between studies of parenteral vs. early enteral nutrition compared to parenteral vs. late enteral. Six trials with complete follow-up reported infectious complications. Infectious complications were increased with parenteral use. The I(2) measure of heterogeneity was 37.7%. Intention to treat trials demonstrated reduced mortality associated with parenteral nutrition use. A priori subgroup analysis attributed this reduction to trials comparing parenteral to delayed enteral nutrition. Despite an association with increased infectious complications, a grade B+ evidence-based recommendation (level II trials, no heterogeneity) can be generated for parenteral nutrition use in patients in whom enteral nutrition cannot be initiated within 24 h of ICU admission or injury.

• Publisher: Springer,Springer Nature B.V
• Subject: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Biological and medical sciences / Case studies / Clinical death. Palliative care. Organ gift and preservation / Clinical trials / Communicable Diseases - etiology / Comparative analysis / Critical Care / Critically ill / Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition / Enteral feeding / Enteral nutrition / Enteral Nutrition - adverse effects / Health aspects / Heterogeneity / Humans / Intensive care / Intensive care medicine / Literature reviews / Medical sciences / Meta-analysis / Mortality / Nutrition / Parenteral feeding / Parenteral nutrition / Parenteral Nutrition - adverse effects / Parenteral therapy / Patients / Randomized Controlled Trials as Topic / Subgroups / Tube feeding