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Intensive Care Medicine
Erschienen in: Intensive Care Medicine 1/2005

01.01.2005 | Systematic Review

Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle

verfasst von: Fiona Simpson, Gordon Stuart Doig

Erschienen in: Intensive Care Medicine | Ausgabe 1/2005

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Abstract

Objective

Controversy surrounds the use of parenteral nutrition in critical illness. Previous overviews used composite scales to identify high-quality trials, which may mask important differences in true methodological quality. Using a component-based approach this meta-analysis investigated the effect of trial quality on overall conclusions reached when standard enteral nutrition is compared to standard parenteral nutrition in critically ill patients.

Methods

An extensive literature search was undertaken to identify all eligible trials. We retrieved 465 publications, and 11 qualified for inclusion. Nine trials presented complete follow-up, allowing the conduct of an intention to treat analysis.

Results

Aggregation revealed a mortality benefit in favour of parenteral nutrition, with no heterogeneity. A priori specified subgroup analysis demonstrated the presence of a potentially important treatment-subgroup interaction between studies of parenteral vs. early enteral nutrition compared to parenteral vs. late enteral. Six trials with complete follow-up reported infectious complications. Infectious complications were increased with parenteral use. The I 2 measure of heterogeneity was 37.7%.

Conclusions

Intention to treat trials demonstrated reduced mortality associated with parenteral nutrition use. A priori subgroup analysis attributed this reduction to trials comparing parenteral to delayed enteral nutrition. Despite an association with increased infectious complications, a grade B+ evidence-based recommendation (level II trials, no heterogeneity) can be generated for parenteral nutrition use in patients in whom enteral nutrition cannot be initiated within 24 h of ICU admission or injury.
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Metadaten
Titel
Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle
verfasst von
Fiona Simpson
Gordon Stuart Doig
Publikationsdatum
01.01.2005
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 1/2005
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-004-2511-2

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