Hill Aileen, Heyland Daren K, Ortiz Reyes Luis A, Laaf Elena, Wendt Sebastian, Elke Gunnar, Stoppe Christian
Department of Intensive Care Medicine, Medical Faculty RWTH Aachen, Aachen, Germany.
Department of Anesthesiology, Medical Faculty RWTH Aachen, Aachen, Germany.
JPEN J Parenter Enteral Nutr. 2022 Feb;46(2):395-410. doi: 10.1002/jpen.2125. Epub 2021 Jun 8.
Uncertainty remains about the best route and timing of medical nutrition therapy in the acute phase of critical illness. Early combined enteral nutrition (EN) and parenteral nutrition (PN) may represent an attractive option to achieve recommended energy and protein goals in select patient groups. This meta-analysis aims to update and summarize the current evidence.
This systematic review and meta-analysis includes randomized controlled trials (RCTs) targeting the effect of EN alone vs a combination of EN with PN in the acute phase of critical illness in adult patients. Assessed outcomes include mortality, intensive care unit (ICU) and hospital length of stay (LOS), ventilation days, infectious complications, physical recovery, and quality-of-life outcomes.
Twelve RCTs with 5543 patients were included. Treatment with a combination of EN with PN led to increased delivery of macronutrients. No statistically significant effect of a combination of EN with PN vs EN alone on any of the parameters was observed: mortality (risk ratio = 1.0; 95% CI, 0.79-1.28; P = .99), hospital LOS (mean difference, -1.44; CI, -5.59 to 2.71; P = .50), ICU LOS, and ventilation days. Trends toward improved physical outcomes were observed in two of four trials.
A combination of EN with PN improved nutrition intake in the acute phase of critical illness in adults and was not inferior regarding the patients' outcomes. Large, adequately designed trials in select patient groups are needed to answer the question of whether this nutrition strategy has a clinically relevant treatment effect.
危重症急性期医学营养治疗的最佳途径和时机仍存在不确定性。早期联合肠内营养（EN）和肠外营养（PN）可能是在特定患者群体中实现推荐能量和蛋白质目标的一个有吸引力的选择。本荟萃分析旨在更新和总结当前证据。
本系统评价和荟萃分析纳入了针对成年患者危重症急性期单独使用EN与EN联合PN效果的随机对照试验（RCT）。评估的结局包括死亡率、重症监护病房（ICU）和医院住院时间（LOS）、通气天数、感染并发症、身体恢复情况和生活质量结局。
纳入了12项RCT，共5543例患者。EN联合PN治疗导致大量营养素的摄入量增加。未观察到EN联合PN与单独使用EN在任何参数上有统计学显著差异：死亡率（风险比 = 1.0；95%CI，0.79 - 1.28；P = 0.99）、医院LOS（平均差，-1.44；CI，-5.59至2.71；P = 0.50）、ICU LOS和通气天数。在四项试验中的两项中观察到身体结局改善的趋势。
EN联合PN可改善成年患者危重症急性期的营养摄入，且在患者结局方面并不逊色。需要在特定患者群体中进行大型、设计充分的试验，以回答这种营养策略是否具有临床相关治疗效果的问题。
