危重症患者的热量供应与临床结局：一项系统评价与荟萃分析。

Calorie delivery and clinical outcomes in the critically ill: a systematic review and meta-analysis.

作者信息

Parikh Harshel G, Miller Asaf, Chapman Marianne, Moran John L, Peake Sandra L

机构信息

Department of Critical Care Medicine, Royal Hobart Hospital, Hobart, TAS, Australia.

Critical Care Services, Royal Adelaide Hospital, Adelaide, SA, Australia.

出版信息

Crit Care Resusc. 2016 Mar;18(1):17-24.

PMID:26947412

Abstract

OBJECTIVES

To determine the effect of calorie delivery on hospital mortality among critically ill adults receiving enteral nutrition (EN). Secondary outcomes included the effect of calorie delivery on intensive care unit and hospital length of stay (LOS), duration of mechanical ventilation (MV) and incidence of new-onset pneumonia.

METHODS

We identified randomised clinical trials of EN, with or without supplemental parenteral nutrition (PN), involving adult ICU patients for whom mortality data were available, and when there was a significant difference in calorie supplementation between intervention arms (P < 0.05). We searched English language electronic databases (1946-2014), bibliographies of nutrition society guidelines and high-impact nutrition and critical care journals. We calculated summary odds ratio (OR) estimates and 95% confidence intervals using a random effects estimator, and used meta-regression to assess the effect on mortality of average calories delivered.

RESULTS

Of 1545 articles identified, 16 eligible studies involving 3473 patients were included. Five studies involved supplemental PN. Mean calorie delivery ranged from 126 kcal/day (SD, 115 kcal/day) to 2086 kcal/day (SD, 460 kcal/day). Mortality was 26.0% in the lower calorie delivery group and 26.5% in the higher calorie delivery group. There was no effect of increased calorie delivery on mortality (OR, 1.02; 95% CI , 0.85-1.24; P = 0.27; I2 = 16.3%). ICU and hospital LOS and incidence of newonset pneumonia did not differ between groups. Duration of MV was decreased with lower calorie delivery (weighted mean difference, 2.92 days; 95% CI, -4.49 to -1.35 days; P < 0.001; I2 = 14.7%). Meta-regression analysis did not show an overall effect on mortality of average calories delivered (P = 0.73; I2 = 40.8%).

CONCLUSION

Delivery of increased calories via the enteral route, with or without supplemental PN, was not associated with a survival benefit.

摘要

目的

确定热量供给对接受肠内营养（EN）的危重症成年患者医院死亡率的影响。次要结局包括热量供给对重症监护病房和医院住院时间（LOS）、机械通气（MV）持续时间以及新发肺炎发生率的影响。

方法

我们纳入了有或无补充肠外营养（PN）的EN随机临床试验，这些试验涉及可获得死亡率数据且各干预组之间热量补充存在显著差异（P<0.05）的成年ICU患者。我们检索了英文电子数据库（1946 - 2014年）、营养学会指南的参考文献以及高影响力的营养和重症监护期刊。我们使用随机效应估计器计算汇总比值比（OR）估计值和95%置信区间，并使用meta回归评估平均热量供给对死亡率的影响。

结果

在检索到的1545篇文章中，纳入了16项符合条件的研究，涉及3473例患者。5项研究涉及补充PN。平均热量供给范围为126千卡/天（标准差，115千卡/天）至2086千卡/天（标准差，460千卡/天）。较低热量供给组的死亡率为26.0%，较高热量供给组为26.5%。热量供给增加对死亡率无影响（OR，1.02；95%置信区间，0.85 - 1.24；P = 0.27；I² = 16.3%）。两组之间ICU和医院LOS以及新发肺炎发生率无差异。较低热量供给时MV持续时间缩短（加权平均差，2.92天；95%置信区间， - 4.49至 - 1.35天；P<0.001；I² = 14.7%）。Meta回归分析未显示平均热量供给对死亡率有总体影响（P = 0.73；I² = 40.8%）。