Fig. 1
Fig. 2
Fig. 3
Primary and secondary outcome of early vs late parenteral nutrition in selected studies
| Study | Mortality | Length of ICU stay | Length of hospital stay | Quality of life | Infection | Organ Failure | Metabolic complications | Gastrointestinal Complications | |
|---|---|---|---|---|---|---|---|---|---|
| Michael P. Casear, 2011 | ICU no. (%) | Median (interquartile range)— days | Median (interquartile range) — days | Functional status at hospital discharge, Distance on 6-min | Any New infection — no. (%) | Modified RIFLE category — no. (%) | Hypoglycemia— no. (%) | X | |
| walk test No. | |||||||||
| EPN(N=2312) | 146 (6.3) | 4 (2-9) | 16 (9-29) | 603 | 605 (26.2) | 131 (5.8) | 45 (1.9) | X | |
| LPN(N=2328) | 141 (6.1) | 3 (2-7) | 14 (9-27) | 624 | 531 (22.8) | 104 (4.6) | 81 (3.5) | X | |
| p value | 0.76 | 0.02 | 0.004 | x | 0.008 | 0.06 | 0.001 | X | |
| Gordon S Doig, 2013 | Deaths study day before 60, No. (%) | Mean (95% CI) | Mean (95% CI) | health RAND-status 36 general mean (SD) | Any major infection No. (%) | Mean (95% CI), | x | X | |
| Standard (n = 680) Care | 155 (22.8) | 9.3 ( 8.9 to 9.7) ) (n = 682) | 24.7 ), ((23.7 n = 682to ) | 45.5 (26.8 ) (n = 516) | 78 (11.4) | 1.47 (1.44 to 1.51) | x | X | |
| Early PN (n = 678) | 146 (21.5) | 8.6 (8.2 to 9.0) (n = 681) | 25.4 (24.4 to 26.6), (n = 681) | 49.8 (27.6) (n = 525) | 74 (10.9) | 1.42 (1.39 to 1.46) | x | X | |
| p value | 0.60 | 0.06 | 0.50 | 0.01 | 0.80 | 0.12 | x | X | |
| Emma J Ridley, 2018 | ICU D/C, n (%) | Median [IQR] | Mean (SD) | x | x | SOFA Score, mean (SE) | x | Vomiting , n (%) | GRV > 300 ml on study days 1-7 |
| Usual Care | 37 (77) | 11 [6-17] | 23 (17) | x | x | 8.0 (0.4) | x | 8 (17) | 23 (48) |
| Intervention | 36 (71) | 11 [5-17] | 22 (21) | x | x | 8.2 (0.4) | x | 13 (26) | 28 (55) |
| p-value | 0.46 | 0.83 | 0.85 | x | x | 0.75 | x | 0.28 | 0.49 |
| Liangliang Hui, 2017 | Hospital (Cases) | x | Mean±SD | x | Peripancreatic (Cases) | Cases | x | GI Bleeding (Cases) | |
| EN+PN | 2 | x | 29.1±1.9 | x | 3 | 3 | x | 4 | |
| PN | 3 | x | 30.1±1.8 | x | 4 | 4 | x | 4 | |
| Ming-chao Fan, 2016 | ICU [n (%)] | Mean±SD | x | x | Intracranial [n (%)] | x | x | Diarrhoea (Cases) n(%) | |
| EN+PN | 4 (10.0) | 27.61 ± 7.54 | x | x | 5 (12.5) | x | x | 8 (20.0) | |
| PN | 17 (42.5) | 36.33 ± 8.61 | x | x | 13 (32.5) | x | x | 6 (15.0) | |
| P value | <0.05 | <0.01 | x | x | <0.05 | x | x | X | |
Basic characteristics of the selected studies
| Study Author (Year) | Study Type | Patient | Intervention Group-1 | Control Group-2 | Group-3 | Outcome Measures |
|---|---|---|---|---|---|---|
| Michael P. Casaer, 2011 | Prospective, randomized, control, parallel- group, Multicenter trial | Critically ill adults in ICU Total= 4640 EPN= 2312 LPN= 2328 | EPN within 48 h of ICU admission | LPN ≥ 8 d of ICU admission | x | Mortality rate, p= 0.76 Length of ICU stay, p=0.02* Length of hospital stay, p= 0.004* Quality of life, Distance= NA Any new infection, p= 0.008* Organ failure, p= 0.06 Metabolic complications (Hypoglycemia), p = 0.001* |
| Gordon S. Doig, 2013 | Randomized, Singleblind clinical trial, Multicenter | Critically ill adults in the ICU Total patients= 1372 Standard care= 686 Early PN= 686 | Early PN | Standard Care (EN/PN/Unfed) | x | Death before study day 60, p=0.60 Length of ICU stay, p= 0.06 Length of hospital stay, p= 0.50 Quality of life, p= 0.01* Infection, p= 0.80 organ failure, p=0.12 |
| Emma J. Ridley, 2018 | Prospective, Parallel group, Phase II pilot trial, Multicentre | Critically ill adults in ICU Total patients = 100 Standard Care= 49 Intervention= 51 | Supplemental PN for 7 d after randomization | Standard Care (EN/PN)- PN was provided when EN was insufficient | x | SOFA Scores= NA Duration of ICU & hospital stay, p=0.83, &0.85 Mortality to 180 days, p= 0.46 |
| Ming-chao Fan, 2016 | Prospective and observational Randomized control trial, Single centric | Patients of Severe traumatic brain injury admitted in Neurological ICU Total= 120 EN= 40 PN=40 EN+PN= 40 | EN within 48 h of ICU admission | PN within 48 h of ICU admission | EN+PN within 48 h of ICU admission | Mortality rate= <0.05 Length of ICU stay= <0.01 Infection = <0.00 0rgan failure, p<0.05 |
| Liangliang Hui, 2017 | RCT, Single Centric | Patients with Severe Acute Pancreatitis Total = 45 EN= 16 TPN= 14 EN+TPN= 15 | EN after 2-4 d of SAP onset | TPN | EN+TPN | Mortality rate= NA gastrointestinal complications = NA pancreatic infection= NA Length of hospital stay= NA |