Sharma Suresh Kumar, Rani Ritu, Thakur Kalpana
All India Institute of Medical Sciences - Rishikesh, Rishikesh, India.
J Crit Care Med (Targu Mures). 2021 Aug 5;7(3):160-169. doi: 10.2478/jccm-2021-0011. eCollection 2021 Jul.
This systematic review aims to evaluate and summarise the findings of all relevant studies which identified the effect of early vs delayed parenteral nutrition (PN), early PN vs early supplemental PN and early PN vs standard care for critically ill adults.
The literature search was undertaken using PubMed, Embase, Medline, Clinical Key, and Ovid discovery databases. The reference lists of studies published from 2000 till June 2020 were hand searched.
On screening 2088 articles, a total of five RCTs with 6,277 patients were included in this review. Only one clinical trial compared early PN and late PN; the results reported significantly shorter periods in intensive care unit (ICU) stay (p=0.02) and less ICU related infections (p=0.008) in the late PN group compared to the Early PN group. Two trials compared total parenteral nutrition (TPN) and enteral nutrition (EN) +TPN groups. Both found a significantly longer hospital stay duration (p<0.05 and p<0.01) with a higher mortality rate in the TPN group compared to the EN+TPN group. A statistically significant improvement was observed in patients' quality of life receiving early PN compared to standard care (p=0.01). In contrast, no significant difference was found in the supplemental PN vs the standard care group.
The supplemental PN patients had shorter ICU stay and lower mortality rates than TPN. However, these findings should be interpreted carefully as included studies have different initiation timing of nutritional support, and the patients' diagnosis varied.
本系统评价旨在评估和总结所有相关研究的结果，这些研究确定了早期与延迟肠外营养（PN）、早期PN与早期补充PN以及早期PN与危重症成年患者标准治疗的效果。
使用PubMed、Embase、Medline、Clinical Key和Ovid发现数据库进行文献检索。对2000年至2020年6月发表的研究的参考文献列表进行手工检索。
在筛选的2088篇文章中，本评价共纳入了5项随机对照试验，涉及6277例患者。只有一项临床试验比较了早期PN和晚期PN；结果显示，与早期PN组相比，晚期PN组在重症监护病房（ICU）的住院时间显著缩短（p = 0.02），与ICU相关的感染更少（p = 0.008）。两项试验比较了全肠外营养（TPN）组和肠内营养（EN）+TPN组。两项试验均发现，与EN+TPN组相比，TPN组的住院时间显著延长（p < 0.05和p < 0.01），死亡率更高。与标准治疗相比，接受早期PN的患者的生活质量有统计学上的显著改善（p = 0.01）。相比之下，补充PN组与标准治疗组之间未发现显著差异。
补充PN患者的ICU住院时间较短，死亡率低于TPN。然而，由于纳入的研究营养支持的起始时间不同，且患者的诊断各异，这些结果应谨慎解读。
