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Annals of Intensive Care 2014Supplemental parenteral nutrition (SPN) is used in a step-up approach when full enteral support is contraindicated or fails to reach caloric targets. Recent nutrition... (Review)
Review
Supplemental parenteral nutrition (SPN) is used in a step-up approach when full enteral support is contraindicated or fails to reach caloric targets. Recent nutrition guidelines present divergent advices regarding timing of SPN in critically ill patients ranging from early SPN (<48 h after admission; EPN) to postponing initiation of SPN until day 8 after Intensive Care Unit (ICU) admission (LPN). This systematic review summarizes results of prospective studies among adult ICU patients addressing the best timing of (supplemental) parenteral nutrition (S)PN. A structured PubMed search was conducted to identify eligible articles. Articles were screened and selected using predetermined criteria and appraised for relevance and validity. After critical appraisal, four randomized controlled trials (RCTs) and two prospective observational studies remained. One RCT found a higher percentage of alive discharge from the ICU at day 8 in the LPN group compared to EPN group (p = 0.007) but no differences in ICU and in-hospital mortality. None of the other RCTs found differences in ICU or in-hospital mortality rates. Contradicting or divergent results on other secondary outcomes were found for ICU length of stay, hospital length of stay, infection rates, nutrition targets, duration of mechanical ventilation, glucose control, duration of renal replacement therapy, muscle wasting and fat loss. Although the heterogeneity in quality and design of relevant studies precludes firm conclusions, it is reasonable to assume that in adult critically ill patients, there are no clinically relevant benefits of EPN compared with LPN with respect to morbidity or mortality end points, when full enteral support is contraindicated or fails to reach caloric targets. However, considering that infectious morbidity and resolution of organ failure may be negatively affected through mechanisms not yet clearly understood and acquisition costs of parenteral nutrition are higher, the early administration of parenteral nutrition cannot be recommended.
PubMed: 25593747
DOI: 10.1186/s13613-014-0031-y -
Medicine Jan 2022Multiple nutritional therapies are currently available for patients with liver cirrhosis, yet many interventions have not been compared head-to-head within randomized...
IMPORTANCE
Multiple nutritional therapies are currently available for patients with liver cirrhosis, yet many interventions have not been compared head-to-head within randomized clinical trials.
OBJECTIVE
To evaluate the improvement of nutritional indicators and liver function indexes of liver cirrhosis treated with different nutrition intervention.
DATA SOURCE
We searched PubMed, Embase. com and Cochrane Library database from construction to April 3, 2020. After eliminating the duplicated or overlapping reports, 6 studies were included. We performed a Bayesian network meta-analysis by Stata 12.0 and GeMTC 0.14.3 in order to compare different nutritional interventions with consistency model.
STUDY SELECTION
Randomized clinical trials comparing 2 or more therapies in patients with cirrhosis were evaluated. Six randomized clinical trials met the selection criteria.
DATA EXTRACTION AND SYNTHESIS
Two investigators independently reviewed the full manuscripts of eligible studies and extracted information into an electronic database: patients' characteristics study design, interventions, the number of events of interest in each group.
MAIN OUTCOMES AND MEASURES
Body mass index, Child-Pugh score, model for end-stage liver disease score, total bilirubin, alanine transaminase, aspartate transaminase, total protein, Triceps skinfold, Midarm Muscle Circumference, Fischer ratio, overall survival.
RESULTS
There are 6 studies enrolling a total of 1148 patients who received different nutrition supports including parenteral nutrition (PN), enteral nutrition (EN), EN (without branched-chain amino acids), EN + intestinal probiotics, PN + EN, late evening snacks (LES), EN + LES, noLES. The direct comparisons showed that the effect of EN was better than EN (without branched-chain amino acids); EN + intestinal probiotics was better than EN and PN; PN + EN was better than them alone; EN + LES was better than LES and EN; LES was better than noLES. Although the difference of indirect comparisons between the included regimens was not statistically significant, the results showed that EN + intestinal probiotics appeared to be superior to PN + EN. While LES and EN + LES seemed to rank behind them and the difference between them was extremely small.
CONCLUSION AND RELEVANCE
Available evidence suggests that EN + intestinal probiotics appear to be the most effective strategy for patients with cirrhosis compared with other interventions.
Topics: Amino Acids, Branched-Chain; Bayes Theorem; End Stage Liver Disease; Enteral Nutrition; Humans; Liver Cirrhosis; Network Meta-Analysis; Parenteral Nutrition; Severity of Illness Index
PubMed: 35060537
DOI: 10.1097/MD.0000000000028618 -
Asia Pacific Journal of Clinical... 2015Although several large-scale clinical trials shave examined the relationship between early parenteral nutrition (ePN) and critically ill patients, a consensus has not... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Although several large-scale clinical trials shave examined the relationship between early parenteral nutrition (ePN) and critically ill patients, a consensus has not been reached. In addition, no meta-analysis in this area has yet been published. The objective of this meta-analysis was to examine the effect of ePN, alone or accompanying enteral nutrition, in critically ill patients.
METHODS
A meta-analysis was performed to evaluate risk ratios (RR) and mean differences with 95% confidence intervals (CIs) between the ePN and control groups. Subgroup analyses were conducted to evaluate combinations of early enteral nutrition (eEN).
RESULTS
Five randomized control trials (RCTs) were included. Compared with controls, ePN had no effect on mortality (RR: 1.05, 95% CI: 0.96, 1.16). Secondary outcomes were variable: compared with the control group, the ePN group required fewer days of ventilation (p=0.007, RR: -0.95, 95% CI: -1.64, -0.27), but a longer hospital stay (p<0.001, RR: 3.76, 95% CI: 2.25, 5.28).
CONCLUSION
Overall, this meta-analysis from RCTs indicates that provision of ePN within 24-48 hours has no benefit on the survival rate in critically ill patients. Thus, provision of ePN in patients is not needed in those who have contraindications to enteral nutrition or can tolerate a low volume of enteral nutrition.
Topics: Critical Illness; Enteral Nutrition; Humans; Length of Stay; Parenteral Nutrition; Time Factors
PubMed: 26078239
DOI: 10.6133/apjcn.2015.24.2.07 -
Advances in Nutrition (Bethesda, Md.) Mar 2016Many studies have reported that olive oil-based lipid emulsion (LE) formulas of soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOF) may be a viable... (Comparative Study)
Comparative Study Meta-Analysis Review
Many studies have reported that olive oil-based lipid emulsion (LE) formulas of soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOF) may be a viable alternative for parenteral nutrition. However, some randomized controlled clinical trials (RCTs) have raised concerns regarding the nutritional benefits and safety of SMOFs. We searched principally the MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Scopus, EMBASE, and Cochrane Central Register of Controlled Trials databases from inception to March 2014 for the relevant literature and conducted a meta-analysis of 15 selected RCTs that 1) compared either olive oil- or SMOF-based LEs with soybean oil-based LEs and 2) reported plasma concentrations of α-tocopherol, oleic acid, and ω-6 (n-6) and ω-3 (n-3) long-chain polyunsaturated fatty acids (PUFAs) and liver concentrations of total bilirubin and the enzymes alanine transaminase, aspartate transaminase, alkaline phosphatase, and γ-glutamyl transferase. The meta-analysis suggested that SMOF-based LEs were associated with higher plasma concentrations of plasma α-tocopherol, oleic acid, and the ω-3 PUFAs eicosapentaenoic and docosahexaenoic acid. Olive oil- and SMOF-based LEs correlated with lower plasma concentrations of long-chain ω-6 PUFAs and were similar to soybean oil-based LEs with regard to their effects on liver function indicators. In summary, olive oil- and SMOF-based LEs have nutritional advantages over soybean oil-based LEs and are similarly safe. However, their performance in clinical settings requires further investigation.
Topics: Deficiency Diseases; Evidence-Based Medicine; Fat Emulsions, Intravenous; Fatty Acids, Essential; Fish Oils; Humans; Olive Oil; Parenteral Nutrition; Randomized Controlled Trials as Topic; Soybean Oil
PubMed: 26980811
DOI: 10.3945/an.114.007427 -
Transplantation and Cellular Therapy Feb 2021Nutritional support for patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been widely debated. Enteral nutrition (EN) is recommended... (Meta-Analysis)
Meta-Analysis
Nutritional support for patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been widely debated. Enteral nutrition (EN) is recommended as first-line nutritional support by the main international guidelines. However, these recommendations are based on weak evidence, and there is wide variability in the types of nutritional support among transplantation centers, with the majority providing parenteral nutrition (PN) instead of EN. Here we provide an up-to-date systematic review and meta-analysis of studies comparing EN and PN for nutritional support during the neutropenic period after allo-HSCT. The literature search strategy identified 13 papers, of which 10 compared clinical transplantation outcomes, 2 compared gut microbiota (GM) compositions, and 1 compared systemic metabolic profiles. For the meta-analysis, among the 10 clinical studies, 8 studies in which 2 groups were compared were selected: in 1 group, EN was provided as primary nutritional support in the neutropenic phase after allo-HSCT with or without the addition of PN (EN group), whereas in the other group, only PN was provided as nutritional support. The incidence rates of acute graft-versus-host disease (aGVHD) (relative risk [RR], 0.69; 95% confidence interval [CI], 0.56 to 0.86; P = .0007), aGVHD grade III-IV (RR, 0.44; 95% CI, 0.30 to 0.64; P < .0001), and gut aGVHD (RR, 0.44; 95% CI, 0.30 to 0.66; P < .0001) were lower in the EN group than in the PN group. No differences were found between the 2 groups with regard to the incidence of severe oral mucositis (RR, 0.95; 95% CI, 0.83 to 1.09; P = .46) or overall survival at day +100 (RR, 1.07; 95% CI, 0.95 to 1.21; P = .29). Other variables were too heterogeneous to perform quantitative analyses. The results of the meta-analysis showed that EN reduced the incidence of aGVHD, specifically grade III-IV and gut aGVHD. This result should prompt improved efforts to implement EN as first-line nutritional support in patients undergoing allo-HSCT. Considering the emerging evidence regarding the association between GM dysbiosis and aGVHD onset, we speculate that this protective effect could be attributed to the improved gut eubiosis observed in enterally fed patients. Further studies are warranted to better address the relationship between the GM composition, aGVHD, and the nutritional administration route during HSCT.
Topics: Enteral Nutrition; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Nutritional Support; Parenteral Nutrition
PubMed: 33830034
DOI: 10.1016/j.jtct.2020.11.006 -
Critical Care (London, England) Nov 2020Omega-3 (ω-3) fatty acid (FA)-containing parenteral nutrition (PN) is associated with significant improvements in patient outcomes compared with standard PN regimens... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Omega-3 (ω-3) fatty acid (FA)-containing parenteral nutrition (PN) is associated with significant improvements in patient outcomes compared with standard PN regimens without ω-3 FA lipid emulsions. Here, we evaluate the impact of ω-3 FA-containing PN versus standard PN on clinical outcomes and costs in adult intensive care unit (ICU) patients using a meta-analysis and subsequent cost-effectiveness analysis from the perspective of a hospital operating in five European countries (France, Germany, Italy, Spain, UK) and the US.
METHODS
We present a pharmacoeconomic simulation based on a systematic literature review with meta-analysis. Clinical outcomes and costs comparing ω-3 FA-containing PN with standard PN were evaluated in adult ICU patients eligible to receive PN covering at least 70% of their total energy requirements and in the subgroup of critically ill ICU patients (mean ICU stay > 48 h). The meta-analysis with the co-primary outcomes of infection rate and mortality rate was based on randomized controlled trial data retrieved via a systematic literature review; resulting efficacy data were subsequently employed in country-specific cost-effectiveness analyses.
RESULTS
In adult ICU patients, ω-3 FA-containing PN versus standard PN was associated with significant reductions in the relative risk (RR) of infection (RR 0.62; 95% CI 0.45, 0.86; p = 0.004), hospital length of stay (HLOS) (- 3.05 days; 95% CI - 5.03, - 1.07; p = 0.003) and ICU length of stay (LOS) (- 1.89 days; 95% CI - 3.33, - 0.45; p = 0.01). In critically ill ICU patients, ω-3 FA-containing PN was associated with similar reductions in infection rates (RR 0.65; 95% CI 0.46, 0.94; p = 0.02), HLOS (- 3.98 days; 95% CI - 6.90, - 1.06; p = 0.008) and ICU LOS (- 2.14 days; 95% CI - 3.89, - 0.40; p = 0.02). Overall hospital episode costs were reduced in all six countries using ω-3 FA-containing PN compared to standard PN, ranging from €-3156 ± 1404 in Spain to €-9586 ± 4157 in the US.
CONCLUSION
These analyses demonstrate that ω-3 FA-containing PN is associated with statistically and clinically significant improvement in patient outcomes. Its use is also predicted to yield cost savings compared to standard PN, rendering ω-3 FA-containing PN an attractive cost-saving alternative across different health care systems.
STUDY REGISTRATION
PROSPERO CRD42019129311.
Topics: Cost-Benefit Analysis; Critical Illness; Fatty Acids, Omega-3; France; Germany; Humans; Intensive Care Units; Italy; Length of Stay; Parenteral Nutrition; Spain; Time Factors; Treatment Outcome; United States
PubMed: 33143750
DOI: 10.1186/s13054-020-03356-w -
The Journal of Nutrition Dec 2013Significant efforts have been made to improve the nutritional support of preterm infants in neonatal intensive care units (NICUs) to avoid cumulative nutritional... (Review)
Review
Significant efforts have been made to improve the nutritional support of preterm infants in neonatal intensive care units (NICUs) to avoid cumulative nutritional deficits, reduce postnatal growth restriction, and promote optimal long-term development. The objective of this systematic review was to compare the characteristics and results of all surveys published in the past 10 y (2002-2012) that used a questionnaire to survey at least 2 NICUs receiving preterm infants with an intention to treat with parenteral nutrition (PN) and that reported information on at least 1 macronutrient. A total of 6 surveys were identified, which were conducted in the United States (n = 2) or Europe (n = 4). There was wide variability in the response rate (23-100%), with a higher response rate in the smaller studies (81-100%; 8-64 respondents) compared with the larger studies (23-58%; 296-809 respondents). Large differences were observed in the nutritional protocols both among the NICUs in the individual surveys and between surveys. PN was initiated on the first day of life (DOL) by only 24-54% of respondents (4 surveys) and within the second DOL by 67-94% of respondents (5 surveys). Lipids were initiated before the third DOL for 46-96% of respondents (3 surveys). The results of this systematic review suggest that continuous education is needed and that greater efforts are required to disseminate and implement guidelines. Repeated surveys are needed to highlight trends in clinical practices and level of compliance of NICUs with existing guidelines.
Topics: Europe; Guideline Adherence; Humans; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Lipids; Parenteral Nutrition; Practice Guidelines as Topic; United States
PubMed: 24108136
DOI: 10.3945/jn.113.176982 -
Nutrients May 2020Malnutrition is associated with poor surgical outcomes, and therefore optimizing nutritional status preoperatively is very important. The purpose of this paper is to...
Malnutrition is associated with poor surgical outcomes, and therefore optimizing nutritional status preoperatively is very important. The purpose of this paper is to review the literature related to preoperative parenteral nutrition (PN) and to provide current evidence based guidance. A systemic online search of PubMed, Medline, and Cochrane Databases from January 1990 to February 2020 was done. Sixteen studies were included in this narrative review, including four meta-analyses and twelve clinical trials. The majority of studies have demonstrated benefits of preoperative PN on postoperative outcomes, including reduced postoperative complications (8/10 studies) and postoperative length of stay (3/4 studies). Preoperative PN is indicated in malnourished surgical patients who cannot achieve adequate nutrient intake by oral or enteral nutrition. It can be seen that most studies showing benefits of preoperative PN often included patients with upper gastrointestinal cancer and inflammatory bowel disease (10/12 studies), which gastrointestinal problems are commonly seen and enteral nutrition may be not feasible. When preoperative PN is indicated, adequate energy and protein should be provided, and patients should receive at least seven days of PN prior to surgery. The goal of preoperative PN is not weight regain, but rather repletion of energy, protein, micronutrients, and glycogen stores. Complications associated with preoperative PN are rarely seen in previous studies. In order to prevent and mitigate the potential complications such as refeeding syndrome, optimal monitoring and early management of micronutrient deficiencies is required.
Topics: Evidence-Based Medicine; Gastrointestinal Neoplasms; Humans; Inflammatory Bowel Diseases; Insurance Benefits; Length of Stay; Malnutrition; Nutrition Assessment; Nutritional Status; Parenteral Nutrition; Postoperative Complications; Practice Guidelines as Topic; Preoperative Care; Prognosis
PubMed: 32384662
DOI: 10.3390/nu12051320 -
Cancers Apr 2022(1) Background: Pancreatic cancer (PaCa) is directly related to malnutrition, cachexia and weight loss. Nutritional interventions (NI) are used in addition to standard... (Review)
Review
(1) Background: Pancreatic cancer (PaCa) is directly related to malnutrition, cachexia and weight loss. Nutritional interventions (NI) are used in addition to standard therapy. The aim of this systematic review is to provide an overview of the types of NI and their effects. (2) Methods: We included RCTs with at least one intervention group receiving an NI and compared them with a control group with no NI, placebo or alternative treatment on cachexia, malnutrition or weight loss in patients with PaCa. Any available literature until 12 August 2021 was searched in the Pubmed and Cochrane databases. RCTs were sorted according to NI (parenteral nutrition, enteral nutrition, dietary supplements and mixed or special forms). (3) Results: Finally, 26 studies with a total of 2720 patients were included. The potential for bias was mostly moderate to high. Parenteral nutrition is associated with a higher incidence of complications. Enteral nutrition is associated with shorter length of stay in hospital, lower rate and development of complications, positive effects on cytokine rates and lower weight loss. Dietary supplements enriched with omega-3 fatty acids lead to higher body weight and lean body mass. (4) Conclusions: Enteral nutrition and dietary supplements with omega-3 fatty acids should be preferred in nutritional therapy of PaCa patients.
PubMed: 35565341
DOI: 10.3390/cancers14092212 -
JPEN. Journal of Parenteral and Enteral... Jan 2020This systematic review and meta-analysis investigated ω-3 fatty-acid enriched parenteral nutrition (PN) vs standard (non-ω-3 fatty-acid enriched) PN in adult... (Meta-Analysis)
Meta-Analysis
This systematic review and meta-analysis investigated ω-3 fatty-acid enriched parenteral nutrition (PN) vs standard (non-ω-3 fatty-acid enriched) PN in adult hospitalized patients (PROSPERO 2018 CRD42018110179). We included 49 randomized controlled trials (RCTs) with intervention and control groups given ω-3 fatty acids and standard lipid emulsions, respectively, as part of PN covering ≥70% energy provision. The relative risk (RR) of infection (primary outcome; 24 RCTs) was 40% lower with ω-3 fatty-acid enriched PN than standard PN (RR 0.60, 95% confidence interval [CI] 0.49-0.72; P < 0.00001). Patients given ω-3 fatty-acid enriched PN had reduced mean length of intensive care unit (ICU) stay (10 RCTs; 1.95 days, 95% CI 0.42-3.49; P = 0.01) and reduced length of hospital stay (26 RCTs; 2.14 days, 95% CI 1.36-2.93; P < 0.00001). Risk of sepsis (9 RCTs) was reduced by 56% in those given ω-3 fatty-acid enriched PN (RR 0.44, 95% CI 0.28-0.70; P = 0.0004). Mortality rate (co-primary outcome; 20 RCTs) showed a nonsignificant 16% reduction (RR 0.84, 95% CI 0.65-1.07; P = 0.15) for the ω-3 fatty-acid enriched group. In summary, ω-3 fatty-acid enriched PN is beneficial, reducing risk of infection and sepsis by 40% and 56%, respectively, and length of both ICU and hospital stay by about 2 days. Provision of ω-3-enriched lipid emulsions should be preferred over standard lipid emulsions in patients with an indication for PN.
Topics: Adult; Cross Infection; Fatty Acids, Omega-3; Humans; Intensive Care Units; Length of Stay; Parenteral Nutrition; Randomized Controlled Trials as Topic; Sepsis
PubMed: 31250474
DOI: 10.1002/jpen.1672