Zhang Zonghong, Zhang Chuanlai, Pan Huiling, Yang Ruiqi, Fang Yin
Intensive Care Unit, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
School of Nursing, Chongqing Medical University, Chongqing, China.
Front Nutr. 2025 Sep 1;12:1645211. doi: 10.3389/fnut.2025.1645211. eCollection 2025.
Critically ill patients often experience low target attainment rates with enteral nutrition (EN), leading to malnutrition and poor clinical outcomes. Energy-dense EN may improve caloric delivery and reduce the risk of malnutrition. However, its effects on other clinical outcomes remain unclear. This systematic review aimed to evaluate the impact of energy-dense EN in critically ill patients.
A systematic search was conducted in PubMed, Embase, Web of Science, Cochrane Library, Clinical Trials, China Knowledge Network Infrastructure (CNKI), Wanfang Data, and Weipu databases from inception to December 2024. Two researchers independently screened studies and extracted data. Randomized controlled trials (RCTs) comparing energy-dense EN with routine EN in critically ill patients were included. Outcomes assessed included diarrhea, gastric residual volume (GRV), vomiting or reflux, mortality, total hospital length of stay (LOS), intensive care unit (ICU) LOS, duration of mechanical ventilation, and nutritional status. The risk of bias was assessed using the Cochrane RoB 2.0 tool. Meta-analyses were performed using Review Manager (RevMan), and the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
A total of 380 studies were identified, and 10 RCTs comprising 4,473 patients were included. Compared with routine EN, energy-dense EN significantly reduced the duration of mechanical ventilation (MD = -37.41, 95% CI: -60.57 to -14.25, = 75%) and ICU LOS (MD = -1.24, 95% CI: -1.49 to -0.99, = 17%). Nutritional indicators such as albumin (MD = 4.92, 95% CI: 2.69-7.16, = 89%) and prealbumin (MD = 55.97, 95% CI: 39.04-72.90, = 86%) were significantly improved. However, there were no significant differences in total hospital LOS, mortality, or gastrointestinal complications such as diarrhea and vomiting/reflux. A slight increase in the risk of high GRV was observed (relative risk (RR) = 1.28, 95% CI: 1.19-1.37, = 2%).
Energy-dense EN appears to be safe and effective for critically ill patients, with benefits in nutritional status and reductions in ICU LOS and mechanical ventilation duration. However, this study has limitations, including potential bias in the included RCTs and inconsistent definitions of GRV. Future large-scale, high-quality, and multicenter RCTs with rigorous methodology are needed to validate these findings.
重症患者肠内营养（EN）的目标达成率往往较低，会导致营养不良及不良临床结局。能量密集型肠内营养可能会改善热量供应并降低营养不良风险。然而，其对其他临床结局的影响仍不明确。本系统评价旨在评估能量密集型肠内营养对重症患者的影响。
从建库至2024年12月，在PubMed、Embase、Web of Science、Cochrane图书馆、临床试验、中国知网（CNKI）、万方数据和维普数据库中进行了系统检索。两名研究人员独立筛选研究并提取数据。纳入比较重症患者能量密集型肠内营养与常规肠内营养的随机对照试验（RCT）。评估的结局包括腹泻、胃残余量（GRV）、呕吐或反流、死亡率、总住院时长（LOS）、重症监护病房（ICU）住院时长、机械通气时长及营养状况。使用Cochrane RoB 2.0工具评估偏倚风险。使用Review Manager（RevMan）进行荟萃分析，并使用推荐分级的评估、制定与评价（GRADE）方法评估证据质量。
共识别出380项研究，纳入了10项RCT，涉及4473例患者。与常规肠内营养相比，能量密集型肠内营养显著缩短了机械通气时长（MD = -37.41，95%CI：-60.57至-14.25，I² = 75%）和ICU住院时长（MD = -1.24，95%CI：-1.49至-0.99，I² = 17%）。白蛋白（MD = 4.92，95%CI：2.69 - 7.16，I² = 89%）和前白蛋白（MD = 55.97，95%CI：39.04 - 72.90，I² = 86%）等营养指标显著改善。然而，总住院时长、死亡率或腹泻和呕吐/反流等胃肠道并发症方面无显著差异。观察到高GRV风险略有增加（相对风险（RR）= 1.28，95%CI：1.19 - 1.37，I² = 2%）。
能量密集型肠内营养对重症患者似乎安全有效，对营养状况有益，并可缩短ICU住院时长和机械通气时长。然而，本研究存在局限性，包括纳入的RCT可能存在偏倚以及GRV定义不一致。未来需要开展大规模、高质量、多中心且方法严谨的RCT来验证这些结果。
