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

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

Background: The amount of energy required to improve clinical outcomes in critically ill adults is unknown. Objective: 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. Design: 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 <80% (standard care) and reported mortality. The quality of individual studies was assessed using the Cochrane 'Risk of Bias' tool, and the overall body of evidence using the GRADE approach. Fixed or random effect meta-analyses were used pending the presence of heterogeneity (I2 > 50%) when 3 or more studies reported the same outcome. Outcomes are presented as risk ratio (RR), 95% confidence interval (CI). Results: 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. Conclusions: 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.

Original languageEnglish
Pages (from-to)1913-1925
Number of pages13
JournalClinical Nutrition
Volume37
Issue number6
DOIs
Publication statusPublished - Dec 2018

Keywords

  • Critically ill
  • Energy
  • Enteral nutrition
  • Meta-analysis
  • Parenteral nutrition
  • Systematic review

Cite this

@article{40220bfadbdf448cab5a2b998a8f59fc,
title = "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",
abstract = "Background: The amount of energy required to improve clinical outcomes in critically ill adults is unknown. Objective: 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. Design: 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 <80{\%} (standard care) and reported mortality. The quality of individual studies was assessed using the Cochrane 'Risk of Bias' tool, and the overall body of evidence using the GRADE approach. Fixed or random effect meta-analyses were used pending the presence of heterogeneity (I2 > 50{\%}) when 3 or more studies reported the same outcome. Outcomes are presented as risk ratio (RR), 95{\%} confidence interval (CI). Results: 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. Conclusions: 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.",
keywords = "Critically ill, Energy, Enteral nutrition, Meta-analysis, Parenteral nutrition, Systematic review",
author = "Ridley, {Emma J.} and Davies, {Andrew R.} and Hodgson, {Carol L.} and Adam Deane and Michael Bailey and Cooper, {D. Jamie}",
year = "2018",
month = "12",
doi = "10.1016/j.clnu.2017.09.026",
language = "English",
volume = "37",
pages = "1913--1925",
journal = "Clinical Nutrition",
issn = "0261-5614",
publisher = "Elsevier",
number = "6",

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TY - JOUR

T1 - Delivery of full predicted energy from nutrition and the effect on mortality in critically ill adults

T2 - A systematic review and meta-analysis of randomised controlled trials

AU - Ridley, Emma J.

AU - Davies, Andrew R.

AU - Hodgson, Carol L.

AU - Deane, Adam

AU - Bailey, Michael

AU - Cooper, D. Jamie

PY - 2018/12

Y1 - 2018/12

N2 - Background: The amount of energy required to improve clinical outcomes in critically ill adults is unknown. Objective: 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. Design: 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 <80% (standard care) and reported mortality. The quality of individual studies was assessed using the Cochrane 'Risk of Bias' tool, and the overall body of evidence using the GRADE approach. Fixed or random effect meta-analyses were used pending the presence of heterogeneity (I2 > 50%) when 3 or more studies reported the same outcome. Outcomes are presented as risk ratio (RR), 95% confidence interval (CI). Results: 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. Conclusions: 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.

AB - Background: The amount of energy required to improve clinical outcomes in critically ill adults is unknown. Objective: 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. Design: 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 <80% (standard care) and reported mortality. The quality of individual studies was assessed using the Cochrane 'Risk of Bias' tool, and the overall body of evidence using the GRADE approach. Fixed or random effect meta-analyses were used pending the presence of heterogeneity (I2 > 50%) when 3 or more studies reported the same outcome. Outcomes are presented as risk ratio (RR), 95% confidence interval (CI). Results: 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. Conclusions: 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.

KW - Critically ill

KW - Energy

KW - Enteral nutrition

KW - Meta-analysis

KW - Parenteral nutrition

KW - Systematic review

UR - http://www.scopus.com/inward/record.url?scp=85031715992&partnerID=8YFLogxK

U2 - 10.1016/j.clnu.2017.09.026

DO - 10.1016/j.clnu.2017.09.026

M3 - Review Article

VL - 37

SP - 1913

EP - 1925

JO - Clinical Nutrition

JF - Clinical Nutrition

SN - 0261-5614

IS - 6

ER -