370 Evaluating the Efficacy and Safety of Intraoperative Enteral Nutrition in Critically Ill Burn Patients: A Systematic Review and Meta-Analysis

BackgroundImpaired adrenal function is a well-described entity in critically ill term and preterm neonates with systemic hypotension. The standard treatment for neonatal hypotension includes volume expanders and vasopressors. Recent evidence supports the use of glucocorticoids for the primary or rescue treatment of neonatal hypotension associated with impaired adrenal function. However, inconsistency regarding the prescribed dosing regimen to provide the best balance between efficacy and safety in this vulnerable population remains an area of concern.MethodsWe will conduct a systematic review and meta-analysis to evaluate low-dosing compared with high-dosing regimens of hydrocortisone for the treatment of hypotension in critically ill term, preterm and very low birth weight neonates. Ovid MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and Web of Science will be searched from inception to November 2021. Study screening and selection will be completed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Our primary outcomes will be (1) an improvement in end-organ perfusion, defined as an increase in blood pressure along with an increase in urine output or a reduction in serum lactate and (2) mortality prior to discharge. Our secondary outcomes will be the development of (1) major neurosensory abnormality, (2) bronchopulmonary dysplasia and (3) the occurrence of adverse events.DiscussionHydrocortisone may be beneficial in the treatment of hypotension associated with impaired adrenal function among critically ill neonates. However, its optimal dosing to balance desired efficacy with the risk of adverse events is yet to be determined. Our systematic review and meta-analysis aims to address this evidence gap, providing valuable knowledge for a large audience, including guideline developers, policy-makers and clinicians.PROSPERO registration numberThis protocol is submitted for registration to the international database of prospectively registered systematic reviews (PROSPERO, awaiting registration number).

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Comparative Efficacy and Safety of Antiulcer Drugs for Stress Ulcer Prophylaxis (SUP) in Critically Ill Patients: A Systematic Review and Network Meta-Analysis

SSRN Electronic Journal ◽

10.2139/ssrn.3205565 ◽

2018 ◽

Author(s):

Pulin Yu ◽

Hongliang Wang ◽

Haitao Liu ◽

Miao Liu ◽

Guiyue Wang ◽

...

Keyword(s):

Systematic Review ◽

Critically Ill ◽

Critically Ill Patients ◽

Stress Ulcer ◽

Meta Analysis ◽

Stress Ulcer Prophylaxis ◽

Efficacy And Safety ◽

Comparative Efficacy ◽

Antiulcer Drugs ◽

Ulcer Prophylaxis

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Efficacy and safety of proton pump inhibitors for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis of randomized trials

Critical Care ◽

10.1186/s13054-016-1305-6 ◽

2016 ◽

Vol 20 (1) ◽

Cited By ~ 60

Author(s):

Fayez Alshamsi ◽

Emilie Belley-Cote ◽

Deborah Cook ◽

Saleh A. Almenawer ◽

Zuhoor Alqahtani ◽

...

Keyword(s):

Systematic Review ◽

Critically Ill ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Critically Ill Patients ◽

Randomized Trials ◽

Stress Ulcer ◽

Meta Analysis ◽

Efficacy And Safety ◽

Ulcer Prophylaxis

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Effect of Supplemental Parenteral Nutrition Versus Enteral Nutrition Alone on Clinical Outcomes in Critically Ill Adult Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Nutrients ◽

10.3390/nu12102968 ◽

2020 ◽

Vol 12 (10) ◽

pp. 2968

Author(s):

Dalal J. Alsharif ◽

Farah J. Alsharif ◽

Ghadeer S. Aljuraiban ◽

Mahmoud M. A. Abulmeaty

Keyword(s):

Systematic Review ◽

Enteral Nutrition ◽

Parenteral Nutrition ◽

Clinical Outcomes ◽

Critically Ill ◽

Nosocomial Infections ◽

Meta Analysis ◽

Controlled Trials ◽

Icu Mortality ◽

Randomized Controlled

Enteral nutrition (EN) is considered the first feeding route for critically ill patients. However, adverse effects such as gastrointestinal complications limit its optimal provision, leading to inadequate energy and protein intake. We compared the clinical outcomes of supplemental parenteral nutrition added to EN (SPN + EN) and EN alone in critically ill adults. Electronic databases restricted to full-text randomized controlled trials available in the English language and published from January 1990 to January 2019 were searched. The risk of bias was evaluated using the Jadad scale, and the meta-analysis was conducted using the MedCalc software. A total of five studies were eligible for inclusion in the systematic review and meta-analysis. Compared to EN alone, SPN + EN decreased the risk of nosocomial infections (relative risk (RR) = 0.733, p = 0.032) and intensive care unit (ICU) mortality (RR = 0.569, p = 0.030). No significant differences were observed between SPN + EN and EN in the length of hospital stay, hospital mortality, length of ICU stay, and duration of mechanical ventilation. In conclusion, when enteral feeding fails to fulfill the energy requirements in critically ill adult patients, SPN may be beneficial as it helps in decreasing nosocomial infections and ICU mortality, in addition to increasing energy and protein intakes with no negative effects on other clinical outcomes.

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