Summary of findings for the main comparison. Enteral versus parenteral nutrition for adults in the intensive care unit.
| Enteral versus parenteral nutrition for adults in the intensive care unit | |||||
| Patient or population: critically ill adults admitted to the ICU for trauma, emergency, or surgical care; population excluded people with acute pancreatitis Setting: intensive care units in: Brazil, China, Germany, Iran, Italy, Turkey, UK, and USA Intervention: EN Comparison: PN | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Certainty of the evidence (GRADE) | |
| Risk with EN | Risk with PN | ||||
| Mortality | In‐hospital mortality | RR 1.19 (0.80 to 1.77) | 361 (6 studies) | ⊕⊕⊝⊝ Lowa | |
| Study population | |||||
| 229 per 1000 (154 to 340) | 192 per 1000 | ||||
| Mortality within 30 days | RR 1.02 (0.92 to 1.13) | 3148 (11 studies) | ⊕⊕⊝⊝ Lowb | ||
| Study population | |||||
| 304 per 1000 (274 to 336) | 298 per 1000 | ||||
| Mortality within 90 days | RR 1.06 (0.95 to 1.17) | 2461 (3 studies) | ⊕⊝⊝⊝ Very lowc | ||
| Study population | |||||
| 393 per 1000 (352 to 434) | 371 per 1000 | ||||
| Mortality within 180 days | RR 0.33 (0.04 to 2.97) | 46 (1 study) | ⊕⊝⊝⊝ Very lowd | ||
| Study population | |||||
| 130 per 1000 | 43 per 1000 (5 in 387) | ||||
| Number of ICU‐free days up to day 28 | – | – | – | – | Not measured |
| Number of ventilator‐free days up to day 28 | Mean number of ventilator‐free days: 14.2 (SD ± 12.2) | Mean difference 0 days (0.97 fewer to 0.97 more) | N/A | 2388 (1 study) | ⊕⊝⊝⊝ Very lowd |
| Adverse events: aspiration (as reported by study authors at end of study follow‐up period) | Study population | RR 1.53 (0.46 to 5.03) | 2437 (2 studies) | ⊕⊝⊝⊝ Very lowe | |
| 5 per 1000 (2 to 17) | 3 per 1000 | ||||
| Adverse events: sepsis (as reported by study authors at end of study follow‐up period) | Study population | RR 0.59 (0.37 to 0.95) | 361 (7 studies) | ⊕⊕⊝⊝ Lowf | |
| 123 per 1000 (77 to 199) | 209 per 1000 | ||||
| Adverse events: pneumonia (as reported by study authors at end of study follow‐up period) | Study population | RR 1.10 (0.82 to 1.48) | 415 (7 studies) | ⊕⊕⊝⊝ Lowf | |
| 314 per 1000 (234 to 423) | 268 per 1000 | ||||
| Adverse events: vomiting (as reported by study authors at end of study follow‐up period) | Study population | RR 3.42 (1.15 to 10.16) | 2525 (3 studies) | ⊕⊝⊝⊝ Very lowg | |
| 11 per 1000 (4 to 32) | 3 per 1000 | ||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; EN: enteral nutrition; ICU: intensive care unit; N/A: not applicable; PN: parenteral nutrition; RR: risk ratio; SD: standard deviation. | |||||
| GRADE Working Group grades of evidence High: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | |||||
aAll studies had a high risk of performance bias; downgraded one level for study limitations. Studies included a variety of primary diagnoses and evidence was less direct; downgraded one level for indirectness.
bAll studies had a high risk of performance bias; downgraded one level for study limitations. Studies included a variety of primary diagnoses and study designs and evidence were less direct; downgraded one level for indirectness.
cAll studies had a high risk of performance bias; downgraded one level for study limitations. Studies included a variety of primary diagnoses and study designs and evidence were less direct; downgraded one level for indirectness. Few studies and one included study had a large number of participants relative to other included studies; downgraded one level for imprecision.
dData from only one study that had a high risk of performance bias; downgraded one level for study limitations and two levels for imprecision.
eAll studies had a high risk of performance bias; downgraded one level for study limitations. Studies included a variety of primary diagnoses and evidence was less direct; downgraded one level for indirectness. Few studies and one included study had a large number of participants relative to other included studies; downgraded one level for imprecision.
fAll studies had a high risk of performance bias; downgraded one level for study limitations. Studies included a variety of primary diagnoses and evidence was less direct; downgraded one level for indirectness.
gAll studies had a high risk of performance bias; downgraded one level for study limitations. Studies included a variety of primary diagnoses and study designs and evidence were less direct; downgraded one level for indirectness. Few studies, with very few events, and one included study had a large number of participants relative to other included studies; downgraded one level for imprecision.