Small bowel feeding and risk of pneumonia in adult critically ill patients: a systematic review and meta-analysis of randomized trials.
Small bowel feeding and risk of pneumonia in adult critically ill patients: a systematic review and meta-analysis of randomized trials.
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DOI：
10.1186/cc12806
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发表时间：
2013-07-02
期刊：
影响因子：
--
通讯作者：
Fox-Robichaud AE
中科院分区：
文献类型：
--
作者：
Alhazzani W;Almasoud A;Jaeschke R;Lo BW;Sindi A;Altayyar S;Fox-Robichaud AE
本系统性综述和荟萃分析旨在评价小肠喂养与胃喂养相比对重症患者肺炎频率和其他患者重要结局的影响。我们检索了1980年至2012年12月的EMBASE、MEDLINE、clinicaltrials.gov和个人档案，以及1993年至2012年12月的会议和会议记录，以比较小肠喂养与胃喂养的重症监护室（ICU）成人危重患者的随机试验，并评价肺炎风险、死亡率、ICU住院时间、热量需求的实现、机械通气时间、呕吐和误吸。独立地，一式两份，我们提取试验特征，结果和偏倚风险。我们纳入了19项试验，1394例患者。与胃饲相比，小肠饲与肺炎风险降低相关（风险比[RR] 0.70; 95% CI，0.55，0.90; P = 0.004; I2 = 0%）和呼吸机相关性肺炎（RR 0.68; 95% CI 0.53，0.89; P = 0.005; I2 = 0%），死亡率无差异（RR 1.08; 95% CI 0.90，1.29; P = 0.43; I2 = 0%），ICU住院时间（WMD -0.57; 95%CI-1.79，0.66; P = 0.37; I2 = 0%），机械通气持续时间（WMD -1.01; 95%CI-3.37，1.35; P = 0.40; I2 = 17%），消化道出血（RR 0.89; 95% CI 0.56，1.42; P = 0.64; I2 = 0%），抽吸（RR 0.92; 95% CI 0.52，1.65; P = 0.79; I2 = 0%）和呕吐（RR 0.91; 95% CI 0.53，1.54; P = 0.72; I2 = 57%）。肺炎结局的总体证据质量较低。与胃饲相比，小肠喂养可降低危重患者发生肺炎的风险，而不会影响死亡率、ICU住院时间或机械通气时间。这些观察结果受到肺炎定义的变化、不精确性、偏倚风险和个体试验样本量小的限制。
This systematic review and meta-analysis aimed to evaluate the effect of small bowel feeding compared with gastric feeding on the frequency of pneumonia and other patient-important outcomes in critically ill patients. We searched EMBASE, MEDLINE, clinicaltrials.gov and personal files from 1980 to Dec 2012, and conferences and proceedings from 1993 to Dec 2012 for randomized trials of adult critically ill patients in the intensive care unit (ICU) comparing small bowel feeding to gastric feeding, and evaluating risk of pneumonia, mortality, length of ICU stay, achievement of caloric requirements, duration of mechanical ventilation, vomiting, and aspiration. Independently, in duplicate, we abstracted trial characteristics, outcomes and risk of bias. We included 19 trials with 1394 patients. Small bowel feeding compared to gastric feeding was associated with reduced risk of pneumonia (risk ratio [RR] 0.70; 95% CI, 0.55, 0.90; P = 0.004; I2 = 0%) and ventilator-associated pneumonia (RR 0.68; 95% CI 0.53, 0.89; P = 0.005; I2 = 0%), with no difference in mortality (RR 1.08; 95% CI 0.90, 1.29; P = 0.43; I2 = 0%), length of ICU stay (WMD -0.57; 95%CI -1.79, 0.66; P = 0.37; I2 = 0%), duration of mechanical ventilation (WMD -1.01; 95%CI -3.37, 1.35; P = 0.40; I2 = 17%), gastrointestinal bleeding (RR 0.89; 95% CI 0.56, 1.42; P = 0.64; I2 = 0%), aspiration (RR 0.92; 95% CI 0.52, 1.65; P = 0.79; I2 = 0%), and vomiting (RR 0.91; 95% CI 0.53, 1.54; P = 0.72; I2 = 57%). The overall quality of evidence was low for pneumonia outcome. Small bowel feeding, in comparison with gastric feeding, reduces the risk of pneumonia in critically ill patients without affecting mortality, length of ICU stay or duration of mechanical ventilation. These observations are limited by variation in pneumonia definition, imprecision, risk of bias and small sample size of individual trials.
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DOI：
10.1186/cc2190
发表时间：
2003-06
期刊：
Critical care (London, England)
影响因子：
--
作者：
Marik PE;Zaloga GP
通讯作者：
Zaloga GP
影响因子：
8.8
作者：
MONTECALVO, MA;STEGER, KA;CRAVEN, DE
通讯作者：
CRAVEN, DE
DOI：
10.1097/00005373-199906000-00002
发表时间：
1999-06-01
影响因子：
--
作者：
Kortbeek, JB;Haigh, PI;Doig, C
通讯作者：
Doig, C
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
8.8
作者：
Davies, Andrew R.;Morrison, Siouxzy S.;Heyland, Daren K.
通讯作者：
Heyland, Daren K.