A combination of enteral and parenteral nutrition in the acute phase of critical illness: An updated systematic review and meta-analysis.

Background Uncertainty remains about the best route and timing of medical nutrition therapy in the acute phase of critical illness. Early combined enteral (EN) and parenteral nutrition (PN) may represent an attractive option to achieve recommended energy and protein goals in select patient groups. This meta-analysis aims to update and summarize the current evidence. Methods This systematic review and meta-analysis includes randomized controlled trials (RCTs) targeting the effect of EN alone vs. a combination of EN with PN in the acute phase of adult critically ill patients. Assessed outcomes include mortality, ICU and hospital-length of stay (LOS), ventilation days, infectious complications, and physical recovery, as well as quality of life outcomes. Results 12 RCTs with 5543 patients were included. Treatment with a combination of EN with PN led to increased delivery of macronutrients. No statistically significant effect of a combination of EN with PN vs. EN alone on any of the parameters were observed: mortality (Risk Ratio 1.0, 95% confidence intervals [CI], 0.79 to 1.28 p = 0.99), hospital LOS (mean difference -1.44, CI -5.59 to 2.71, p = 0.50), ICU LOS and ventilation days. Trends toward improved physical outcomes were observed in two of four trials. Conclusion A combination of EN with PN improved nutrition intake in the acute phase of critically ill adults and was not inferior regarding the patient´s outcomes. Large, adequately designed trials in select patient groups are needed to answer the question if this nutritional strategy has a clinically relevant treatment effect. This article is protected by copyright. All rights reserved.