scholarly journals A combination of enteral and parenteral nutrition in the acute phase of critical illness: An updated systematic review and meta‐analysis

Author(s):  
Aileen Hill ◽  
Daren K. Heyland ◽  
Luis A. Ortiz Reyes ◽  
Elena Laaf ◽  
Sebastian Wendt ◽  
...  
Author(s):  
Abbas Heydari ◽  
Aliakbar Keykha

Background: With regard to critical illness and stress, medication side effects, decreased appetite, and increased nausea and vomiting; patients admitted to intensive care units (ICUs) are at particular risk of malnutrition. Feeding behavior i.e. time and method in these patients has still remained as an unresolved issue. Thus; enteral and parenteral nutrition, with their own benefits and complications, are two commonly used methods for such individuals. The present systematic review was to compare the effects of enteral and parenteral nutrition in patients admitted to ICUs. Methods: This systematic review investigated a total number of 1642 articles on nutrition methods in ICU patients during 2010-2019 using keywords of “enteral nutrition, parenteral nutrition solutions, parenteral nutrition, critical care outcomes, critical illness, intensive care unit, and ICU” in the databases of SID, Iranmedex, MEDLIB-ED, PubMed, Scopus, Medline, Embase, Cochrane, Web of Science, and Google Scholar; and finally, 15 articles were analyzed in relation to the research objectives. Results: Studies indicated that patient mortality was not different in enteral and parenteral nutrition groups. The incidence rate of infectious complications was also reported higher in parenteral nutrition group. However, there was no significant difference in the incidence rate of infections in studies meeting total standards for parenteral nutrition. Besides, there was no significant difference between the duration of undergoing mechanical ventilation and hospitalization time in both groups. Furthermore, the incidence rate of hypoglycemia was higher in enteral nutrition group; but serum protein levels had much better status compared with those in parenteral nutrition group. Conclusion: If standards for infusion are observed and provided that rates of infectious complications are reduced, patients can benefit from starting parenteral nutrition immediately after admission to ICUs in the absence of enteral method.


2020 ◽  
pp. archdischild-2019-318245
Author(s):  
Ming-Hsiu Chiang ◽  
Hsingjin Eugene Liu ◽  
Jinn-Li Wang

ObjectiveTo compare the efficacy of low-dose or no aspirin with conventional high-dose aspirin for the initial treatment in the acute-phase of Kawasaki disease (KD).DesignA meta-analysis and systematic review of randomised control trials and cohort studies.MethodsAll available articles that compared different dosage of aspirin in the acute-phase of KD published until 20 September 2019 were included from the databases of PubMed, Embase and Cochrane Central Register of Controlled Trials Central without language restrictions. Extracted data from eligible studies were reviewed by two authors independently and analysed by using RStudio software.ResultsNine cohorts with a total of 12 182 children were enrolled. We found that low-dose (3–5 mg/kg/day) or no aspirin in the acute-phase KD was associated with reducing the risk of coronary artery lesions (CALs, OR=0.81, 95% CI 0.69 to 0.95). No differences were observed in intravenous immunoglobulin resistance, length of hospital stay and fever days after admission (OR=1.35, 95% CI 0.91 to 1.98; standard mean difference (SMD)=0.17, 95% CI −1.07 to 1.4; SMD=0.3, 95% CI −1.51 to 2.11) in the low-dose/no aspirin subgroup compared with the high-dose (≥30 mg/kg/day) aspirin subgroup. We did not identify any potential factors affecting the homogeneity of CAL risk as well as clinical important effects in all included studies.ConclusionsPrescribing low-dose or no aspirin in the acute-phase of KD might be associated with a decreased incidence of CAL. However, additional well-designed prospective trials are required to support the theory.


Nutrients ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 2865 ◽  
Author(s):  
Jose M. Comeche ◽  
Iris Comino ◽  
Cesare Altavilla ◽  
Jose Tuells ◽  
Ana Gutierrez-Hervas ◽  
...  

Inflammatory bowel disease (IBD) is a chronic disease mediated by the immune system and characterized by the inflammation of the gastrointestinal tract. This study is to understand how the use of parenteral nutrition (PN) can affect the adult population diagnosed with IBD. We conducted a systematic review, meta-analysis, and meta-regression. From the different databases (MEDLINE, Scopus, Cochrane, LILACS, CINAHL, WOS), we found 119 registers with an accuracy of 16% (19 registers). After a full-text review, only 15 research studies were selected for qualitative synthesis and 10 for meta-analysis and meta-regression. The variables used were Crohn’s Disease Activity Index (CDAI), albumin, body weight (BW), and postoperative complications (COM). PN has shown to have efficacy for the treatment of IBD and is compatible with other medicines. The CDAI and albumin improve, although the effect of PN is greater after a while. However, the effect on the albumin could be less than the observed value in the meta-analysis due to possible publication bias. The BW does not change after intervention. COM utilizing PN has been observed, although the proportion is low. More studies specifically referring to ulcerative colitis (UC) and Crohn’s disease (CD) are needed to develop more concrete clinical results.


2020 ◽  
Vol 48 (1) ◽  
pp. 535-535
Author(s):  
Swaroopa Nalamalapu ◽  
Selina Parry ◽  
Krishidhar Nunna ◽  
Anahita Rabiee ◽  
Lisa Friedman ◽  
...  

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e039813
Author(s):  
Xinxing Lai ◽  
Jian Liu ◽  
Tianyi Zhang ◽  
Luda Feng ◽  
Ping Jiang ◽  
...  

IntroductionWith the threat of a worldwide pandemic of COVID-19, it is important to identify the prognostic factors for critical conditions among patients with non-critical COVID-19. Prognostic factors and models may assist front-line clinicians in rapid identification of high-risk patients, early management of modifiable factors, appropriate triaging and optimising the use of limited healthcare resources. We aim to systematically assess the clinical, laboratory and imaging predictors as well as prediction models for severe or critical illness and mortality in patients with COVID-19.Methods and analysisAll peer-reviewed and preprint primary articles with a longitudinal design that focused on prognostic factors or models for critical illness and mortality related to COVID-19 will be eligible for inclusion. A systematic search of 11 databases including PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, VIP, Wanfang Data, SinoMed, bioRxiv, Arxiv and MedRxiv will be conducted. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data extraction will be performed using the modified version of the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist and quality will be evaluated using the Newcastle-Ottawa Scale and the Quality In Prognosis Studies tool. The association between prognostic factors and outcomes of interest will be synthesised and a meta-analysis will be conducted with three or more studies reporting a particular factor in a consistent manner.Ethics and disseminationEthical approval was not required for this systematic review. We will disseminate our findings through publication in a peer-reviewed journal.PROSPERO registration numberCRD 42020178798.


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