Phan K A, Dux C M, Osland E J, Reade M C
Intensivist, Intensive Care Medicine, University of Queensland and Burns, Trauma and Critical Care Research Centre, Brisbane, Queensland, Joint Health Command, Australian Defence Force, Canberra, Australian Capital Territory.
Anaesth Intensive Care. 2017 Nov;45(6):663-675. doi: 10.1177/0310057X1704500604.
Uncertainty surrounds the optimal approach to feeding the critically ill, with increasing interest in the concept of intentional underfeeding to reduce metabolic stress while maintaining gut integrity. Conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, this systematic review evaluates clinical outcomes reported in studies comparing hypocaloric normonitrogenous or trophic feeding (collectively 'intentional underfeeding') targeted full energy feeding administered via enteral nutrition to adult critically ill patients. Electronic databases including PubMed, CINAHL, EMBASE and CENTRAL were searched up to September 2017 for trials evaluating intentional underfeeding versus targeted energy feeding interventions on clinical outcomes (mortality, length of stay, duration of ventilation, infective complications, feeding intolerance and glycaemic control) among critically ill adult patients. Bias of included studies was assessed using the Cochrane risk of bias tool. Of the 595 articles identified, seven studies (six randomised controlled trials, one non-randomised trial) met the inclusion criteria, representing 2,684 patients (hypocaloric normonitrogenous n=668; trophic n=681; full energy feeding n=1335). Across the studies, there was considerable heterogeneity in study methodology, population, feeding strategy and outcomes and their timepoints. We observed no evidence that intentional underfeeding, when compared to targeting full energy feeding, reduced mortality or duration of ventilation or length of stay. However, limited trial evidence is available on the impact of intentional underfeeding on post-discharge functional and quality of life outcomes.
重症患者的最佳喂养方式尚无定论，人们越来越关注适度限制喂养的概念，即减少代谢应激同时维持肠道完整性。本系统评价按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行，评估了比较低热量正常氮量喂养或滋养性喂养（统称为“适度限制喂养”）与通过肠内营养给予成人重症患者目标能量喂养的研究中报告的临床结局。检索了包括PubMed、CINAHL、EMBASE和CENTRAL在内的电子数据库，截至2017年9月，查找评估适度限制喂养与目标能量喂养干预对重症成年患者临床结局（死亡率、住院时间、通气时间、感染并发症、喂养不耐受和血糖控制）影响的试验。使用Cochrane偏倚风险工具评估纳入研究的偏倚。在识别出的595篇文章中，7项研究（6项随机对照试验、1项非随机试验）符合纳入标准，共2684例患者（低热量正常氮量喂养组n = 668；滋养性喂养组n = 681；目标能量喂养组n = 1335）。在各项研究中，研究方法、人群、喂养策略、结局及其时间点存在相当大的异质性。我们没有观察到证据表明，与目标能量喂养相比，适度限制喂养能降低死亡率、通气时间或住院时间。然而，关于适度限制喂养对出院后功能和生活质量结局影响的试验证据有限。
