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Table 1 Characteristics of studies included in the systematic review

From: Lower versus higher dose of enteral caloric intake in adult critically ill patients: a systematic review and meta-analysis

Author, year

Population

Design

Number of patients

Age (mean)

Male (%)

APACHE II (mean)

MV

Intervention (daily caloric intake)

Control (daily caloric intake)

Duration of intervention

Montecalvo et al., 1992 [54]a

Medical and surgical

RCT

38

50.5 years in the intervention group, 44.8 years in the control group

60.5

Acute physiology score of APACHE II 24.0 in the intervention group, 21.7 in the control group

Not reported Probably all

Jejunal feeding (1182 ± 603 kcal; 46.9 ± 25.9 % of goal)

Gastric feeding (1466 ± 398 kcal; 61.0 ± 17 % of goal)

As long as tube feeding was required Mean tube feeding was 10 days

Kearns et al., 2000 [55]

Medical

RCT

44

54 years in the intervention group, 49 years in the control group

68

22 in the intervention group, 20 in the control group

100 %

Small intestinal feeding (1157 ± 86 kcal; 18 ± 1 kcal/kg/day; 69 ± 7 % of caloric requirement) Protein intake: 0.7 ± 0.1 g/kg/kg/day

Gastric feeding (812 ± 122 kcal; 12 ± 2 kcal/kg/day; 47 ± 7 % of caloric requirement). Protein intake 0.4 ± 0.1 g/kg/kg/day

7–10 days

Chen et al., 2006 [56]a

Medical

RCT

107

Similar age distribution in the control and intervention groups

76.6

Similar APACHE II distribution in both groups

100 %

Continuous feeding, with calories significantly different from the other group

Intermittent feeding

Not clear At least 7 days

Nguyen et al., 2007 [57]a

Medical

RCT

75

50.9 years in the intervention group, 52 years in the control group

70

23 in the intervention group, 22.6 in the control group

100 %

Combination prokinetic therapy (erythromycin and metoclopramide) Significantly higher caloric intake

Erythromycin alone Lower caloric intake

7 days

Desachy et al., 2008 [58]a

Medical and surgical

RCT

100

64 years in the interventional group, 58 years in the control group

69

APACHE II is not reported SAPS II: 40 in gradual feeding group, 42 in immediate feeding group

100 %

Gradual feeding 76 % of optimal calorie intake (1297 ± 331 kcal)

Immediate feeding 95 % of optimal calorie intake (1715 ± 331 kcal)

120 ± 48 hours (similar in the two groups); 45 patients were followed for maximum of 7 days

Hsu et al., 2009 [59]

Medical

RCT

121

70 years in the intervention, 67.9 years in the control group

70.2

20.5 in the intervention group, 20.3 in the control group

100 %

Nasoduodenal feeding group (1658 ± 118 kcal; 27.1 ± 7.6 kcal/kg/day) Protein intake: 1.11 ± 0.31 g/kg/day

Nasogastric feeding group (1426 ± 110 kcal; 23.5 ± 8.8 kcal/kg/day) Protein intake 0.97 ± 0.39 g/kg/day

Mean study period was 11 days

White et al., 2009 [60]

Medical

RCT

104

50 years in the intervention group, 54 years in the control group

50

30 in the intervention group, 24.5 in the control group

100 %

Postpyloric feeding (1296 kcal; 88.5 % of caloric requirement) Average protein deficit 6.5 g/day

Gastric feeding (1515 kcal; 95 % of caloric requirement) Average protein deficit 3.5 g/day

Not reported Mean gastric feeding duration was 3.1 days, mean postpyloric feeding duration was 4.0 days

Montejo et al., 2010 [61]a

Medical and surgical

RCT

329

65 years in the intervention group, 60 years in the control group

65

19.4 in the intervention group, 18.9 in the control group

100 %

High gastric residual volume of 500 ml (diet volume ratio in the first week = 88.2 %)

Low gastric residual volume of 200 ml (diet volume ratio in the first week = 84.5 %)

The duration of enteral nutrition (maximum of 28 days)

Acosta-Escribano et al., 2010 [62]a

Severe traumatic brain injury

RCT

104

35 years in the intervention group, 41 years in the control group

86.5

16 in the intervention group, 18 in the control group

100 %

Transpyloric feeding (92 % of the feeding volume given)

Gastric feeding (84 % of the feeding volume given)

Not reported

Arabi et al., 2011 [14]

Medical and surgical

RCT

240

50.3 years in the intervention group, 5.19 years in the control group

68.3

25.2 in the intervention group, 25.3 in the control group

99.2 %

Permissive under feeding: 59 % of requirement (1066 ± 306 kcal; 13.9 kcal/kg/day) Protein intake 0.61 g/kg/day

Target feeding 71.4 % of requirement (1251 ± 432 kcal; 16.4 kcal/kg/day) Protein intake 0.57 g/kg/day

Duration of enteral feeding or ICU discharge

Singer et al., 2011 [63]

Medical, surgical and trauma

RCT

130

59 years in the intervention group, 62 years in the control group

58

22.1 in the intervention group, 22.4 in the control group

100 %

Tight caloric intake according to indirect calorimetry (2086 ± 467 kcal) Protein intake 0.95 g/kg/day

Standard caloric intake at 25 kcal/kg/day (1480 ± 356 kcal) Protein intake 0.68 g/kg/day

Not clear. Till day 14 or discharge from the ICU

Rice et al., 2011 [15]

Acute respiratory failure

RCT

200

53 years in the intervention group, 54 years in the control group

44

26.9 in both groups

100 %

Trophic feeding (300 ± 149 kcal; 15.8 ± 11 % of caloric requirement) Protein intake: 0.13 g/kg/day

Full feeding (1418 ± 686 kcal; 74.8 ± 38.5 % of caloric requirement) Protein intake 0.66 g/kg/day

6 days

Rice et al., 2012 [16]a

ARDS patients (medical, surgical and trauma)

RCT

1000

52 years in the intervention and control groups

51

APACHE III: 92 in the intervention group, 90 in the control group

100 %

Trophic feeding (400 kcal; 25 % of estimated non-protein caloric requirement)

Full feeding (1300 kcal; 80 % of estimated caloric requirement)

6 days

Huang et al., 2012 [64]

Medical

RCT

101

70.9 years in the intervention group, 68.3 years in the control group

71

21.0 in the intervention group, 19.6 in the control group

100 %

Nasoduodenal feeding (1575 kcal; 90.4 % of target energy intake). Protein intake 93.2 ± 26.9 % of target

Nasogastric feeding (1343 kcal; 76.2 % of target energy intake) Protein intake 78.6 ± 28.5 % of target

21 days

Reignier et al., 2013 [65]a

Medical and surgical

RCT

449

61 years in the intervention group, 62 years in the control group

70

Baseline SOFA 8 for both groups

100 %

Not monitoring residual gastric volume (calorie deficit 319 kcal)

Monitoring residual gastric volume (calorie deficit 509 kcal)

Not clear Follow up for 90 days

Rugeles et al., 2013 [23]

Medical and surgical

RCT

80

53.3 years in the intervention group, 55.7 years in the control group

58

13.9 in the intervention group, 15.1 in the control group

 

Hyperproteic hypocaloric enteral nutrition as 15 kcal/kg/day (756 kcal) Protein intake 1.4 g/kg/day

Standard nutritional regimen as 25 kcal/kg/day (921 kcal) Protein intake 0.76 g/kg/day

7 days

Peake et al., 2014 [66]

Mechanically ventilated (medical and surgical)

RCT

112

56.4 years in the intervention group, 56.5 years in the control group

74

23 in the intervention group, 22 in the control group

100 %

Nutritional formula 1.5 kcal/ml (1832 ± 381 kcal; 27.3 ± 7.4 kcal/kg; 96.0 % of requirement) Protein intake 75 % of target

Nutritional formula 1 kcal/ml (1259 ± 428 kcal; 19.0 ± 6.0 kcal/kg; 68.4 % of requirement) Protein intake 79 % of target

10 days

Charles et al., 2014 [22]

Surgical/ trauma

RCT

83

50.4 years in the intervention group, 53.4 years in the control group

71

16.6 in the intervention group, 17.3 in the control group

62.7 %

Hypocaloric feeding: 50 % of estimated requirement as 12.5-15 kcal/kg/day (982 ± 61 kcal; 12.3 ± 0.7 kcal/kg/day) Protein intake 1.1 g/kg/day

Eucaloric feeding 100 % of estimated requirement as 25–30 kcal/kg/day (1338 ± 92 kcal; 17.1 ± 1.1 kcal/kg/day) Protein intake 1.1 g/kg/day

Not clear

Braunschweig et al., 2015 [67]

Acute lung injury patients (medical and surgical)

RCT

78

52.5 years in the intervention group, 58.6 years in the intervention group

51.2

23.4 in the intervention group, 27.7 in the control group

 

Intensive medical nutrition: >75 % of estimated energy and protein needs by a multifaceted approach (1798 ± 509 kcal; 25.4 ± 6.6 kcal/kg/day; 84.7 % of energy needs) Protein intake 0.95 g/kg/day

Standard nutrition support care (1221 ± 423 kcal; 16.6 ± 5.6 kcal/kg/day; 55.4 % of energy needs) Protein intake 0.68 g/kg/day

Till hospital discharge

Arabi et al., 2015 [68]

Medical and surgical

RCT

894

50.2 years in the intervention group, 50.9 years in the control group

64.2

21.0 in the intervention and control groups

96.8 %

Permissive underfeeding 40–60 % of caloric requirements: (835 ± 297 kcal; 46 % of requirement) Protein intake 0.72 g/kg/day

Standard feeding: 70–100 % of caloric requirements (1299 ± 467 kcal; 71 % of requirement) Protein intake 0.73 g/kg/day

Up to 14 days

Doig et al., 2015 [69]a

Medical and surgical

RCT

331

59 years in the intervention group, 61 years in the control group

58.6

18 in the intervention and control groups

91 %

Protocolized caloric restriction 20 kcal/h for ≥2 days then caloric intake adjusted depending on serum phosphate

Standard care, mean caloric intake at enrolment 68.5 kcal/h

At least 4 days

  1. aProtein intake not reported. APACHE Acute Physiology and Chronic Health Evaluation, ARDS acute respiratory distress syndrome, MV mechanical ventilation, RCT randomized controlled trial, SAPS Simplified Acute Physiology Score. SOFA Sequential Organ Failure Assessment