title: Initial energy supplementation in critically ill patients receiving enteral nutrition: a systematic review and meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  Here we systematically reviewed and quantitatively analyzed randomized controlled trials (RCTs) to compare the important initial outcomes of critically ill adults receiving low- and highenergy enteral nutrition.
  
  
  METHODS
  RCTs comparing low- and high-energy supplementation in critically ill adults receiving enteral nutrition admitted to the intensive care unit for an expected stay of >48 h were included. Abstracts submitted to major scientific meetings were included and the primary endpoint was mortality. The risk ratio (RR) and weighted mean difference (WMD) with 95% confidence intervals (CIs) were the effect measures.
  
  
  RESULTS
  Eleven RCTs (3,212 patients) were included. The groups did not differ significantly in mortality (RR, 0.94; 95% CI, 0.80-1.11; p=0.47), infections morbidity (RR 1.09; 95% CI 0.95-1.26; p=0.23), pneumonia morbidity (RR 1.04; 95% CI 0.88-1.23; p=0.68), hospital length of stay (WMD -0.27; 95% CI -3.21 to 3.76; p=0.88), intensive care unit length of stay (WMD -0.32; 95% CI, -1.81 to 1.16; p=0.46), mechanical ventilation days (WMD -0.30; 95% CI-1.42 to 0.82; p=0.60). The incidence of gastrointestinal intolerance was significantly lower in the low-energy group (RR 0.79; 95% CI 0.65-0.97; p<0.05).
  
  
  CONCLUSIONS
  The initial administration of low- versus high-energy supplements did not impact clinical outcomes except for gastrointestinal intolerance in non-malnourished critically ill patients receiving enteral nutrition. The initial administration of highrather than low-energy may benefit these patients by reducing infections, but this effect might actually be attributable to the concomitant high protein intake.
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Tian
authors.affiliation: Department of General Surgery, Jinling Hospital, South Medical University, Guangdong Province, China.
authors.forename: Xuejin
authors.initials: X
authors.lastname: Gao
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Wu
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Xianfeng
authors.initials: X
authors.lastname: Xia
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China. Email: wxinying@263.net.
authors.forename: Xinying
authors.initials: X
authors.lastname: Wang
mesh_terms: D000328:Adult; D015897:Comorbidity; D016638:Critical Illness; D004044:Dietary Proteins / Q000008:administration & dosage; D019587:Dietary Supplements; D002149:Energy Intake; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007239:Infections / Q000453:epidemiology; D007362:Intensive Care Units; D007902:Length of Stay; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial; D016896:Treatment Outcome
chemical_list: D004044:Dietary Proteins