Efficacy of permissive underfeeding for critically ill patients: an updated systematic review and trial sequential meta-analysis.

IF 3.8 2区医学 Q1 CRITICAL CARE MEDICINE Journal of Intensive Care Pub Date : 2024-01-23 DOI:10.1186/s40560-024-00717-3

Han-Yang Yue, Wei Peng, Jun Zeng, Yang Zhang, Yu Wang, Hua Jiang

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Abstract

Background: Our previous study in 2011 concluded that permissive underfeeding may improve outcomes in patients receiving parenteral nutrition therapy. This conclusion was tentative, given the small sample size. We conducted the present systematic review and trial sequential meta-analysis to update the status of permissive underfeeding in patients who were admitted to the intensive care unit (ICU).

Methods: Seven databases were searched: PubMed, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature Database, and Cochrane Library. Randomized controlled trials (RCTs) were included. The Revised Cochrane risk-of-bias tool (ROB 2) was used to assess the risk of bias in the enrolled trials. RevMan software was used for data synthesis. Trial sequential analyses (TSA) of overall and ICU mortalities were performed.

Results: Twenty-three RCTs involving 11,444 critically ill patients were included. There were no significant differences in overall mortality, hospital mortality, length of hospital stays, and incidence of overall infection. Compared with the control group, permissive underfeeding significantly reduced ICU mortality (risk ratio [RR] = 0.90; 95% confidence interval [CI], [0.81, 0.99]; P = 0.02; I² = 0%), and the incidence of gastrointestinal adverse events decreased (RR = 0.79; 95% CI, [0.69, 0.90]; P = 0.0003; I² = 56%). Furthermore, mechanical ventilation duration was reduced (mean difference (MD) = - 1.85 days; 95% CI, [- 3.44, - 0.27]; P = 0.02; I² = 0%).

Conclusions: Permissive underfeeding may reduce ICU mortality in critically ill patients and help to shorten mechanical ventilation duration, but the overall mortality is not improved. Owing to the sample size and patient heterogeneity, the conclusions still need to be verified by well-designed, large-scale RCTs. Trial Registration The protocol for our meta-analysis and systematic review was registered and recorded in PROSPERO (registration no. CRD42023451308). Registered 14 August 2023.

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重症患者允许少喂食的疗效：最新系统综述和试验序列荟萃分析。

背景：我们之前在 2011 年进行的研究得出结论，允许喂养不足可能会改善接受肠外营养治疗患者的预后。由于样本量较小，这一结论还只是初步的。我们进行了本系统综述和试验序列荟萃分析，以更新重症监护室（ICU）住院患者允许性少喂食的现状：方法：检索了七个数据库：方法：检索了七个数据库：PubMed、Embase、Web of Science、中国国家知识基础设施、万方数据库、中国生物医学文献数据库和 Cochrane 图书馆。纳入随机对照试验（RCT）。使用修订版 Cochrane 偏倚风险工具（ROB 2）评估入选试验的偏倚风险。RevMan 软件用于数据综合。对总体死亡率和重症监护室死亡率进行了试验序列分析（TSA）：结果：共纳入 23 项 RCT，涉及 11,444 名重症患者。在总死亡率、住院死亡率、住院时间和整体感染率方面没有明显差异。与对照组相比，允许喂养不足显著降低了重症监护室死亡率（风险比 [RR] = 0.90；95% 置信区间 [CI]，[0.81, 0.99]；P = 0.02；I2 = 0%），胃肠道不良事件的发生率也有所降低（RR = 0.79；95% CI，[0.69, 0.90]；P = 0.0003；I2 = 56%）。此外，机械通气持续时间缩短（平均差（MD）= - 1.85 天；95% CI，[- 3.44，- 0.27]；P = 0.02；I2 = 0%）：允许喂养不足可降低重症患者在重症监护室的死亡率，并有助于缩短机械通气时间，但总体死亡率并未得到改善。由于样本量和患者的异质性，该结论仍需通过精心设计的大规模研究实验来验证。试验注册我们的荟萃分析和系统综述方案已在 PROSPERO（注册号：CRD42023451308）注册并记录在案。注册日期为 2023 年 8 月 14 日。

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来源期刊

Journal of Intensive Care Medicine-Critical Care and Intensive Care Medicine

CiteScore

11.90

自引率

1.40%

发文量

审稿时长

15 weeks

期刊介绍： "Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction. Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.