Table 2.
Methodology and relevant outcome parameters of the included randomized clinical trials of enteral versus parenteral nutrition in critically ill patients
| Study | Methods (score) | Mortality, N (%)a | Infections, N (%)b | LOS, days, mean ± SD (N) | Mechanical ventilation, days, mean ± SD (N) | Caloric intakec | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| EN | PN | EN | PN | EN | PN | EN | PN | EN | PN | ||
| 1. Rapp et al. 1983 [37] | C.Random: not sure | 9/18 (50) | 3/20 (15) | NR | Hospital 49.4d | Hospital 52.6d | 10.3d | 10.4d | 685 P = 0.001 |
1750 | |
| ITT: no | |||||||||||
| Blinding: no (4) | |||||||||||
| 2. Adams et al. 1986 [38] | C.Random: not sure | 1/23 (4) | 3/23 (13) | 15/23 (65) | 17/23 (74) | ICU 13 ± 11 (19) | ICU 10 ± 10 (17) | 12 ± 11 (17) | 10 ± 10 (13) | 2088 NSf | 2572 |
| ITT: yes | Hospital 30 ± 21 (19) | Hospital 31 ± 29 (17) | |||||||||
| Blinding: no (8) | |||||||||||
| 3. Young et al. 1987 [39] | C.Random: not sure | 10/28 (36) | 10/23 (43) | 5/28 (18) | 4/23 (17) | NR | NR | 1671 P = 0.02 |
2299 | ||
| ITT: no | |||||||||||
| Blinding: no (6) | |||||||||||
| 4. Peterson et al. 1988 [40] | C.Random: not sure | NR | 2/21 (10) | 8/25 (32) | ICU 3.7 ± 0.8 (21) | ICU 4.6 ± 1.0 (25) | NR | Kcal on day 5 | |||
| 2204 P = 0.04 |
2548 | ||||||||||
| ITT: no | Hospital 13.2 ± 1.6 (21) | Hospital 14.6 ± 1.9 (24) | |||||||||
| Blinding: no (5) | |||||||||||
| 5. Cerra et al. 1988 [41] | C.Random: not sure | ICU 7/31 (22) | ICU 8/35 (23) | NR | NR | NR | Non-protein kcal | ||||
| 1684 NSf | 2000 | ||||||||||
| ITT: no | |||||||||||
| Blinding: no (2) | |||||||||||
| 6. Moore et al. 1989 [42] | C.Random: yes | NR | 5/29 (17) | 11/30 (37) | NR | NR | Non-protein kcal on day 5 | ||||
| ITT: no | 1847 P = 0.01 |
2261 | |||||||||
| Blinding: no (10) | |||||||||||
| 7. Kudsk et al. 1992 [43] | C.Random: not sure | ICU 1/51 (2) | ICU 1/45 (2) | 9/51 (16) | 18/45 (40) | Hospital 20.5 ± 19.9 (51) | Hospital 19.6 ± 18.8 (45) | 2.8 ± 4.9 (51) | 3.2 ± 6.7 (45) | Kcal/kg/d | |
| ITT: no | 15.7 P < 0.05 |
19.1 | |||||||||
| Blinding: single (10) | |||||||||||
| 8. Dunham et al. 1994 [44] | C.Random: not sure | 1/12 (7) | 1/15 (8) | NR | NR | NR | NSf | ||||
| ITT: no | |||||||||||
| Blinding: no (8) | |||||||||||
| 9. Borzotta et al. 1994 [45] | C.Random: not sure | 5/28 (18) | 1/21 (5) | 51/28 (28) | 39/21 (21) | Hospitale 39 ± 23.1 | Hospitale 36.9 ± 14 | NR | 2097 NSf | 1961 | |
| ITT: no | |||||||||||
| Blinding: no (6) | |||||||||||
| 10. Hadfield et al. 1995 [46] | C.Random: not sure | ICU 2/13 (15) | ICU 6/11 (55) | NR | NR | NR | NSf | ||||
| ITT: no | |||||||||||
| Blinding: no (7) | |||||||||||
| 11. Kalfarentzos et al. 1997 [47] | C.Random: not sure | ICU 1/18 (6) | ICU 2/20 (10) | 5/18 (28) | 0/20 (50) | ICU 11 (5–21)d | ICU 12 (5–24)d | 15 (6–16)d | 11 (7–31)d | Non-protein kcal/kg/d | |
| ITT: no | Hospital 40 (25–83)d | Hospital 39 (22–73)d | 24.1 NSf | 24.5 | |||||||
| Blinding: single (9) | |||||||||||
| 12. Woodcock et al. 2001 [27] | C.Random: yes | 9/17 (53) | 5/21 (24) | 6/16 (38) | 11/21 (52) | 33.2 ± 43 (16) | 27.3 ± 18.7 (18) | NR | % caloric target (30 kcal/kg/d) achieved | ||
| ITT: yes | 54.1 P < 0.001 |
96.7 | |||||||||
| Blinding: single (12) | |||||||||||
| 13. Casas et al. 2007 [48] | C.Random: no/unsure | Hospital 0/11 (0) | Hospital 2/11 (18) | 1/11 (9) | 3/11 (27) | Hospital 30.2 (average) | Hospital 30.7 (average) | NR | Kcal/kg/d | ||
| ITT: Yes | 20.1 NSf | 20.8 | |||||||||
| Blinding: no (8) | |||||||||||
| 14. Chen et al. 2011 [49] | C.Random: yes | 20-day 11/49 (22) | 20-day 10/49 (20) | 5/49 (10) | 18/49 (37) | ICU 9.09 ± 2.75 | ICU 9.60 ± 3.06 | 7.95 ± 2.11 | 8.23 ± 2.42 | NR | |
| ITT: yes | |||||||||||
| Blinding: no (7) | Hospital 23.32 ± 5.6 | Hospital 22.24 ± 3.27 | |||||||||
| 15. Justo Meirelles et al. 2011 [21] | C.Random: no | Not specified 1/12 (8.3) | Not specified 1/10 (10) | Total infectious complications 2/12 (16.7) | Total infectious complications 4/10 (40) | ICU 14 (5–26) | ICU 14 (6–24) | NR | Cumulative kcal over 5d | ||
| ITT: no | Pneumonia 2/12 (16.7) | Pneumonia 2/10 (20) | 5985 P = 0.34 |
6586 | |||||||
| Blinding: no (5) | Sepsis 0 | Sepsis 2/10 (20) | |||||||||
| 16. Wang et al. 2013 [22] | C.Random: no | Hospital 3/61 (5) | Hospital 7/60 (12) | Pancreatic sepsis 13/61 (21) | Pancreatic sepsis 24/60 (40) | NR | NR | NR | |||
| ITT: no | |||||||||||
| Blinding: double (7) | MODS 15/61 (24.6) | MODS 22/60 (36.7) | |||||||||
| 17. Sun et al. 2013 [50] | C.Random: no | Hospital 2/30 (7) | Hospital 1/30 (3) | Pancreatic 3/30 (10) | Pancreatic 10/30 (33) | ICU 9 (5–14) | ICU 12 (8–21) | NR | NR | ||
| ITT: no | MODS 5/30 (17) | MODS 13/30 (43) | |||||||||
| Blinding: no (6) | SIRS 12/30 (40) | SIRS 22/30 (73) | |||||||||
| 18. Harvey et al. 2014 [16] | C.Random: yes | ICU 352/1197 (29.4) | ICU 317/1190 (26.6) | Total infectious complications 194/1197 (16.2)g | Total infectious complications 194/1191 (16.3)g | ICU 11.3 ± 12.5 (1197) | ICU 12 ± 13.5 (1190) | 8.2 ± 9.3 (1197) | 8.7 ± 11.5 (1189) | Cumulative kcal/kg/d over 5d | |
| ITT: yes | Hospital 450/1186 (37.9) | Hospital 431/1185 (36.4) | Pneumonia 143/1197 (11.9) | Pneumonia 135/1191 (11.3) | Hospital 26.8 ± 33.2 (1186) | Hospital 27.5 ± 33.9 (1185) | 74 NSf | 89 | |||
| 30-day 409/1195 (34.2) | 30-day 393/1188 (33.1) | Bloodstream infections 21/1197 (1.8) | Bloodstream infections 27/1191 (2.9) | ||||||||
| Blinding: no (8) | 90-day 464/1188 (39.1) | 90-day 442/1184 (37.3) | Surgical infections 12/1197 (1.0) | Surgical infections 10/1191 (0.8) | |||||||
Data are presented as total number and percentage for mortality and infections. Data are presented as mean ± standard deviation with total number of patients per group shown in brackets for LOS and mechanical ventilation
C.Random concealed randomization, d days, ITT intention to treat, kcal kilocalories, LOS length of stay, MODS multiple organ dysfunction syndrome, N number, NR not reported, NS not significant, SIRS systemic inflammatory response syndrome
aPresumed hospital mortality unless otherwise specified
bRefers to the number of patients with infections unless otherwise specified
cCaloric intake is presented as the mean daily kcal during the studies’ intervention period or as otherwise specified
dMedian/mean values, no standard deviation reported hence not included in meta-analysis
ePresumed hospital length of stay
fNo data on caloric intake or P value provided, respectively but caloric intake reported to be non-significantly different in the manuscript
gData on ICU patients obtained directly from authors