Delivery of full predicted energy from nutrition and the effect on mortality in critically ill adults: A systematic review and meta-analysis of randomised controlled trials

The amount of energy required to improve clinical outcomes in critically ill adults is unknown. The aim of this systematic review and meta-analysis was to evaluate the impact of near target energy delivery to critically ill adults on mortality and other clinically relevant outcomes. Following PRISMA...

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Bibliographic Details
Published in:Clinical nutrition (Edinburgh, Scotland) Scotland), 2018-12, Vol.37 (6), p.1913-1925
Main Authors: Ridley, Emma J., Davies, Andrew R., Hodgson, Carol L., Deane, Adam, Bailey, Michael, Cooper, D. Jamie
Format: Article
Language:English
Subjects:
Critically ill
Energy
Enteral nutrition
Meta-analysis
Parenteral nutrition
Systematic review
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Summary:The amount of energy required to improve clinical outcomes in critically ill adults is unknown. The aim of this systematic review and meta-analysis was to evaluate the impact of near target energy delivery to critically ill adults on mortality and other clinically relevant outcomes. Following PRISMA guidelines, MEDLINE, EMBASE, CINHAL and the Cochrane Library were searched for randomised controlled trials evaluating nutrition interventions in adult critical care populations. Included studies compared delivery of ≥80% of predicted energy requirements (near target) from enteral and/or parenteral nutrition to  50%) when 3 or more studies reported the same outcome. Outcomes are presented as risk ratio (RR), 95% confidence interval (CI). Ten trials with 3155 participants were included. Mortality was unaffected by the intervention (RR 1.02, 95% CI 0.81, 1.27, p = 0.89, I2 = 25%). Evaluation of studies of higher quality and low risk of bias did not alter the mortality inference (3 trials, 352 participants, RR 0.83, 95% CI 0.49, 1.40, p = 0.19, I2 = 39%). The quality of evidence across outcomes was very low. The delivery of near target energy when compared to standard care in adult critically ill patients was not associated with an effect on mortality. Because the quality of the evidence across outcomes was very low there is considerable uncertainty surrounding this estimate. This has implications for clinical utility of the evidence within the included reviews.
ISSN:0261-5614
1532-1983
DOI:10.1016/j.clnu.2017.09.026