Skip to main content

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