危重儿科人群的早期肠内营养和临床结果:系统回顾和荟萃分析。

IF 6 1区 医学 Q1 CRITICAL CARE MEDICINE
Nicole Gilbert, Emma Schalm, Krista Wollny, Laurie Lee, Dana L Boctor, Tanis R Fenton
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引用次数: 0

摘要

目的:指南推荐在危重儿童中实施早期肠内营养(EN) (EEN)。该研究的目的是确定与延迟肠内营养(DEN)相比,危重儿童的EEN是否与改善的临床结果相关,并根据疾病严重程度调整优先关系。普洛斯彼罗(CRD42021286271)。数据来源:截至2024年10月的MEDLINE, Embase, CINAHL和CENTRAL数据库。研究选择:人群为危重儿童,干预措施为EEN,比较物为DEN,结果为死亡率或临床结果,研究设计包括随机对照试验(rct)、准实验、观察队列或病例对照。资料提取:筛选、提取和偏倚风险评估采用纽卡斯尔-渥太华量表和Cochrane偏倚风险和建议分级评估、发展和评价(GRADE)评估,由两名审稿人进行一式两份。8478项筛选研究中有18项被纳入。数据综合:采用随机效应模型对死亡率结果进行汇总和荟萃分析。对次要结局进行定性描述,并报告相关方向。13项研究(1项随机对照试验,12项队列研究)报告了死亡率;然而,只有三个人根据疾病严重程度进行了调整。在校正分析中,接受EEN与死亡率降低相关(校正优势比0.36 (95% CI, 0.14-0.91), I2 = 78.6%, n = 5864)。根据GRADE评估,证据的确定性由于间接性而非常低。在对18项研究(1项随机对照试验,17项队列研究,n = 9829)的定性回顾中,EEN与住院时间缩短、有创呼吸支持时间延长、营养充足性改善、儿童后勤器官功能障碍评分降低和感染有关。在调整混杂变量后,未发现EEN的有害影响。结论:EEN与有益结果相关。然而,纳入的大多是混杂调整有限的队列研究,研究数量少,研究间存在异质性和残留混杂,测量结果和评估方法存在异质性,导致证据的确定性非常低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Early Enteral Nutrition and Clinical Outcomes in Critically Ill Pediatric Populations: A Systematic Review and Meta-Analysis.

Objective: Guidelines recommend implementing early enteral nutrition (EN) (EEN) in critically ill children. The aim of the study was to determine if EEN for critically ill children is associated with improved clinical outcomes compared with delayed enteral nutrition (DEN), prioritizing associations adjusted for severity of illness. PROSPERO (CRD42021286271).

Data sources: MEDLINE, Embase, CINAHL, and CENTRAL databases to October 2024.

Study selection: The population was critically ill children, the intervention was EEN, the comparator was DEN, the outcome was mortality or clinical outcomes, and the study designs included randomized control trials (RCTs), quasi-experimental, observational cohort, or case-control.

Data extraction: Screening, extraction, and risk of bias assessment using the Newcastle-Ottawa Scale and Cochrane Risk of Bias and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment were conducted in duplicate by two reviewers. Eighteen of 8478 screened studies were included.

Data synthesis: Mortality outcomes were pooled and meta-analyzed using random-effects models. Secondary outcomes were described qualitatively, and directions of associations were reported. Thirteen studies (1 RCT, 12 cohort) reported mortality; however, only three adjusted for illness severity. In the adjusted analysis, receiving EEN was associated with reduced mortality (adjusted odds ratio 0.36 (95% CI, 0.14-0.91), I2 = 78.6%, n = 5864). The certainty of evidence, as assessed by GRADE, was very low due to indirectness. In the qualitative review of 18 studies (1 RCT, 17 cohort studies, n = 9829), EEN had an association with reduced length of stay, length of invasive respiratory support, improved nutrition adequacy, reduced maximum pediatric logistic organ dysfunction score, and infection. No harmful effects of EEN were found after adjusting for confounding variables.

Conclusions: EEN was associated with beneficial outcomes. However, the inclusion of mostly cohort studies with limited confounding adjustment, the small number of studies, the presence of between-study heterogeneity and residual confounding, and heterogeneity in measured outcomes and assessment methods resulted in very low certainty of evidence.

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来源期刊
Critical Care Medicine
Critical Care Medicine 医学-危重病医学
CiteScore
16.30
自引率
5.70%
发文量
728
审稿时长
2 months
期刊介绍: Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.
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