Li Jianbo, Wang Lijie, Zhang Huan, Zou Tongjuan, Kang Yan, He Wei, Xu Yuan, Yin Wanhong
Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China.
Department of Critical Care Medicine, Beijing Tongren Hospital of Capital Medical University, Beijing, 100730, China.
J Intensive Care. 2023 Jul 5;11(1):29. doi: 10.1186/s40560-023-00674-3.
A unified clinical definition of feeding intolerance (FI) is urged for better management of enteral nutrition (EN) in critically ill patients. We aimed to identify optimum clinical FI definitions based on reported evidence.
We searched clinical studies comparing FI with non-FI with a clear definition, summarized the evidence by random-effect meta-analyses, and rated the certainty of evidence by the Grading of Recommendations Assessment, Development and Evaluation frameworks.
Five thousand five hundred twenty-five records were identified, of which 26 eligible studies enrolled 25,189 adult patients. Most patient-centered outcomes were associated with FI overall. Low to very low certainty evidence established FI defined as large gastric residual volume (GRV) ≥ 250 ± 50 mL combined with any other gastrointestinal symptoms (GIS) had a significant association with high mortalities in particular all-cause hospital mortality (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.40-2.57), the incidence of pneumonia (OR 1.54, 95% CI 1.13-2.09) and prolonged length of hospital stay (mean difference 4.20, 95% CI 2.08-6.32), with a moderate hospital prevalence (41.49%, 95% CI 31.61-51.38%). 3-day enteral feeding (EF) delivered percentage < 80% had a moderate hospital prevalence (38.23%, 95% CI 24.88-51.58) but a marginally significant association with all-cause hospital mortality (OR 1.90, 95% CI 1.03-3.50).
In critically ill adult patients receiving EN, the large-GRV-centered GIS to define FI seemed to be superior to 3-day EF-insufficiency in terms of both close associations with all-cause hospital mortality and acceptable hospital prevalence (Registered PROSPERO: CRD42022326273).
The protocol for this review and meta-analysis was registered with PROSPERO: CRD42022326273. Registered 10 May 2022.
为了更好地管理重症患者的肠内营养（EN），迫切需要对喂养不耐受（FI）进行统一的临床定义。我们旨在根据已发表的证据确定最佳的临床FI定义。
我们检索了比较FI与非FI且定义明确的临床研究，通过随机效应荟萃分析总结证据，并根据推荐分级评估、制定和评价框架对证据的确定性进行评级。
共识别出5525条记录，其中26项符合条件的研究纳入了25189例成年患者。大多数以患者为中心的结局总体上与FI相关。低至极低确定性证据表明，将FI定义为大胃残余量（GRV）≥250±50 mL并伴有任何其他胃肠道症状（GIS），与高死亡率尤其全因医院死亡率（优势比[OR]1.90，95%置信区间[CI]1.40-2.57）、肺炎发生率（OR 1.54，95%CI 1.13-2.09）和住院时间延长（平均差4.20，95%CI 2.08-6.32）显著相关，医院患病率中等（41.49%，95%CI 31.61-51.38%）。3天肠内喂养（EF）提供百分比<80%，医院患病率中等（38.23%，95%CI 24.88-51.58），但与全因医院死亡率的关联微弱显著（OR 1.90，95%CI 1.03-3.50）。
在接受EN的成年重症患者中，以大GRV为中心的GIS定义FI在与全因医院死亡率的密切关联和可接受的医院患病率方面似乎优于3天EF不足（注册PROSPERO：CRD42022326273）。
本综述和荟萃分析的方案已在PROSPERO注册：CRD42022326273。2022年5月10日注册。
