Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis
Abstract Background The use of indirect calorimetry (IC) is increasing due to its precision in resting energy expenditure (REE) measurement in critically ill patients. Thus, we aimed to evaluate the clinical outcomes of an IC-guided nutrition therapy compared to predictive equations strategy in such...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-02-01
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| Series: | Critical Care |
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| Online Access: | https://doi.org/10.1186/s13054-021-03508-6 |
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| author | Jing-Yi Duan Wen-He Zheng Hua Zhou Yuan Xu Hui-Bin Huang |
| author_facet | Jing-Yi Duan Wen-He Zheng Hua Zhou Yuan Xu Hui-Bin Huang |
| author_sort | Jing-Yi Duan |
| collection | DOAJ |
| description | Abstract Background The use of indirect calorimetry (IC) is increasing due to its precision in resting energy expenditure (REE) measurement in critically ill patients. Thus, we aimed to evaluate the clinical outcomes of an IC-guided nutrition therapy compared to predictive equations strategy in such a patient population. Methods We searched PubMed, EMBASE, and Cochrane library databases up to October 25, 2020. Randomized controlled trials (RCTs) were included if they focused on energy delivery guided by either IC or predictive equations in critically ill adults. We used the Cochrane risk-of-bias tool to assess the quality of the included studies. Short-term mortality was the primary outcome. The meta-analysis was performed with the fixed-effect model or random-effect model according to the heterogeneity. Results Eight RCTs with 991 adults met the inclusion criteria. The overall quality of the included studies was moderate. Significantly higher mean energy delivered per day was observed in the IC group, as well as percent delivered energy over REE targets, than the control group. IC-guided energy delivery significantly reduced short-term mortality compared with the control group (risk ratio = 0.77; 95% CI 0.60 to 0.98; I 2 = 3%, P = 0.03). IC-guided strategy did not significantly prolong the duration of mechanical ventilation (mean difference [MD] = 0.61 days; 95% CI − 1.08 to 2.29; P = 0.48), length of stay in ICU (MD = 0.32 days; 95% CI − 2.51 to 3.16; P = 0.82) and hospital (MD = 0.30 days; 95% CI − 3.23 to 3.83; P = 0.87). Additionally, adverse events were similar between the two groups. Conclusions This meta-analysis indicates that IC-guided energy delivery significantly reduces short-term mortality in critically ill patients. This finding encourages the use of IC-guided energy delivery during critical nutrition support. But more high-quality studies are still needed to confirm these findings. |
| first_indexed | 2024-12-16T16:31:01Z |
| format | Article |
| id | doaj.art-134fb50ccfaf46998468059183305031 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-16T16:31:01Z |
| publishDate | 2021-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-134fb50ccfaf469984680591833050312022-12-21T22:24:35ZengBMCCritical Care1364-85352021-02-0125111010.1186/s13054-021-03508-6Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysisJing-Yi Duan0Wen-He Zheng1Hua Zhou2Yuan Xu3Hui-Bin Huang4Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua UniversityDepartment of Critical Care Medicine, Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese MedicineDepartment of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua UniversityDepartment of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua UniversityDepartment of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua UniversityAbstract Background The use of indirect calorimetry (IC) is increasing due to its precision in resting energy expenditure (REE) measurement in critically ill patients. Thus, we aimed to evaluate the clinical outcomes of an IC-guided nutrition therapy compared to predictive equations strategy in such a patient population. Methods We searched PubMed, EMBASE, and Cochrane library databases up to October 25, 2020. Randomized controlled trials (RCTs) were included if they focused on energy delivery guided by either IC or predictive equations in critically ill adults. We used the Cochrane risk-of-bias tool to assess the quality of the included studies. Short-term mortality was the primary outcome. The meta-analysis was performed with the fixed-effect model or random-effect model according to the heterogeneity. Results Eight RCTs with 991 adults met the inclusion criteria. The overall quality of the included studies was moderate. Significantly higher mean energy delivered per day was observed in the IC group, as well as percent delivered energy over REE targets, than the control group. IC-guided energy delivery significantly reduced short-term mortality compared with the control group (risk ratio = 0.77; 95% CI 0.60 to 0.98; I 2 = 3%, P = 0.03). IC-guided strategy did not significantly prolong the duration of mechanical ventilation (mean difference [MD] = 0.61 days; 95% CI − 1.08 to 2.29; P = 0.48), length of stay in ICU (MD = 0.32 days; 95% CI − 2.51 to 3.16; P = 0.82) and hospital (MD = 0.30 days; 95% CI − 3.23 to 3.83; P = 0.87). Additionally, adverse events were similar between the two groups. Conclusions This meta-analysis indicates that IC-guided energy delivery significantly reduces short-term mortality in critically ill patients. This finding encourages the use of IC-guided energy delivery during critical nutrition support. But more high-quality studies are still needed to confirm these findings.https://doi.org/10.1186/s13054-021-03508-6Indirect calorimetryCritically illEnergy deliveryMortalityMeta-analysis |
| spellingShingle | Jing-Yi Duan Wen-He Zheng Hua Zhou Yuan Xu Hui-Bin Huang Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis Critical Care Indirect calorimetry Critically ill Energy delivery Mortality Meta-analysis |
| title | Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis |
| title_full | Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis |
| title_fullStr | Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis |
| title_full_unstemmed | Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis |
| title_short | Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis |
| title_sort | energy delivery guided by indirect calorimetry in critically ill patients a systematic review and meta analysis |
| topic | Indirect calorimetry Critically ill Energy delivery Mortality Meta-analysis |
| url | https://doi.org/10.1186/s13054-021-03508-6 |
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