Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Commercial Road, Melbourne, 3004, Australia; Nutrition Department, Alfred Health, Commercial Road, Melbourne, 3004, Australia.
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Commercial Road, Melbourne, 3004, Australia.
Clin Nutr. 2018 Dec;37(6 Pt A):1913-1925. doi: 10.1016/j.clnu.2017.09.026. Epub 2017 Oct 9.
The amount of energy required to improve clinical outcomes in critically ill adults is unknown.
The aim of this systematic review and meta-analysis was to evaluate the impact of near target energy delivery to critically ill adults on mortality and other clinically relevant outcomes.
Following PRISMA guidelines, MEDLINE, EMBASE, CINHAL and the Cochrane Library were searched for randomised controlled trials evaluating nutrition interventions in adult critical care populations. Included studies compared delivery of ≥80% of predicted energy requirements (near target) from enteral and/or parenteral nutrition to <80% (standard care) and reported mortality. The quality of individual studies was assessed using the Cochrane 'Risk of Bias' tool, and the overall body of evidence using the GRADE approach. Fixed or random effect meta-analyses were used pending the presence of heterogeneity (I > 50%) when 3 or more studies reported the same outcome. Outcomes are presented as risk ratio (RR), 95% confidence interval (CI).
Ten trials with 3155 participants were included. Mortality was unaffected by the intervention (RR 1.02, 95% CI 0.81, 1.27, p = 0.89, I = 25%). Evaluation of studies of higher quality and low risk of bias did not alter the mortality inference (3 trials, 352 participants, RR 0.83, 95% CI 0.49, 1.40, p = 0.19, I = 39%). The quality of evidence across outcomes was very low.
The delivery of near target energy when compared to standard care in adult critically ill patients was not associated with an effect on mortality. Because the quality of the evidence across outcomes was very low there is considerable uncertainty surrounding this estimate. This has implications for clinical utility of the evidence within the included reviews.
目前尚不清楚为改善危重症成人的临床结局所需的能量。
本系统评价和荟萃分析旨在评估将危重症成人的能量接近目标输送对死亡率和其他临床相关结局的影响。
根据 PRISMA 指南，检索 MEDLINE、EMBASE、CINHAL 和 Cochrane 图书馆中评估成人重症监护人群营养干预的随机对照试验。纳入的研究比较了经肠和/或肠外营养输送≥80%预测能量需求（接近目标）与<80%（标准护理）的能量，并报告了死亡率。使用 Cochrane“风险偏倚”工具评估单个研究的质量，并使用 GRADE 方法评估总体证据质量。当 3 项或更多研究报告相同结局时，采用固定或随机效应荟萃分析，取决于是否存在异质性（I>50%）。结果表示为风险比（RR），95%置信区间（CI）。
纳入 10 项试验，共 3155 名参与者。干预对死亡率无影响（RR 1.02，95% CI 0.81，1.27，p=0.89，I=25%）。对高质量、低偏倚风险的研究进行评估并未改变死亡率推断（3 项试验，352 名参与者，RR 0.83，95% CI 0.49，1.40，p=0.19，I=39%）。各项结局的证据质量均为极低。
与标准护理相比，在成年危重症患者中接近目标的能量输送与死亡率无关联。由于各项结局的证据质量极低，因此对这一估计存在很大的不确定性。这对纳入的综述中证据的临床实用性有影响。
