Scolaris Content Display Scolaris Content Display

Nutrición enteral versus nutrición parenteral y enteral versus una combinación de nutrición enteral y parenteral para adultos en la unidad de cuidados intensivos

Appendices

Appendix 1. CENTRAL search strategy

#1 MeSH descriptor: [Enteral Nutrition] explode all trees
#2 feeding tube* or PEG line* or EN or ((enteral or enteric) near (nutrition or feeding))
#3 #1 or #2
#4 MeSH descriptor: [Parenteral Nutrition] explode all trees
#5 MeSH descriptor: [Plasma Substitutes] explode all trees
#6 (nutrition adj5 venous line*) or PN or ((parenteral or intravenous) near (nutrition or feeding))
#7 #4 or #5 or #6
#8 ICU or (critical* near (ill* or care)) or septic* or sepsis or feeding therap* or plasma substitute*
#9 MeSH descriptor: [Sepsis] explode all trees
#10 MeSH descriptor: [Shock, Septic] explode all trees
#11 MeSH descriptor: [Intensive Care Units] explode all trees
#12 MeSH descriptor: [Multiple Organ Failure] explode all trees
#13 MeSH descriptor: [Systemic Inflammatory Response Syndrome] explode all trees
#14 MeSH descriptor: [Critical Illness] explode all trees
#15 MeSH descriptor: [Critical Care] explode all trees
#16 #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15
#17 #3 and #7 and #16 in Trials

Appendix 2. MEDLINE (OvidSP) search strategy

  1. (feeding tube* or PEG line* or EN or ((enteral or enteric) adj5 (nutrition or feeding))).mp. or exp Enteral Nutrition/

  2. ((nutrition adj5 venous line*) or PN or ((parenteral or intravenous) adj5 (nutrition or feeding))).mp. or exp Parenteral Nutrition/ or Plasma Substitutes/ or plasma substitute*.mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

  3. (ICU or (critical* adj5 (ill* or care))).mp. or (septic* or sepsis).ti,ab. or Sepsis/ or Shock, Septic/ or exp Intensive Care Units/ or exp Critical Illness/ or exp Critical Care/ or Multiple Organ Failure/ or Systemic Inflammatory Response Syndrome/ or feeding therap*.ti,ab.

  4. ((randomized controlled trial or controlled clinical trial).pt. or randomi?ed.ab. or placebo.ab. or drug therapy.fs. or randomly.ab. or trial.ab. or groups.ab.) not (animals not (humans and animals)).sh.

  5. 1 and 2 and 3 and 4

Appendix 3. Embase (OvidSP) search strategy

  1. (feeding tube* or PEG line* or EN or ((enteral or enteric) adj5 (nutrition or feeding))).mp. or exp enteric feeding/

  2. ((nutrition adj5 venous line*) or PN or ((parenteral or intravenous) adj5 (nutrition or feeding))).mp. or exp Parenteral Nutrition/ or Plasma Substitute/ or plasma substitute*.mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword, floating subheading word]

  3. (patient* adj5 (ICU or (critically adj3 (ill* or care)))).mp. or ICU.ti,ab. or (critical* adj3 ill*).ti,ab. or (septic* or sepsis).ti,ab. or Sepsis/ or septic shock/ or exp Intensive Care Unit/ or Critical Illness/ or Multiple Organ Failure/ or Systemic Inflammatory Response Syndrome/ or exp Intensive Care/ or feeding therap*.ti,ab.

  4. ((crossover procedure or double blind procedure or single blind procedure).sh. or (crossover* or cross over*).ti,ab. or placebo*.ti,ab,sh. or (doubl* adj blind*).ti,ab. or (controlled adj3 (study or design or trial)).ti,ab. or allocat*.ti,ab. or trial*.ti,ab. or randomized controlled trial.sh. or random*.ti,ab.) not ((exp animal/ or animal.hw. or nonhuman/) not (exp human/ or human cell/ or (human or humans).ti.))

  5. 1 and 2 and 3 and 4

Flow diagram of search strategy.
Figures and Tables -
Figure 1

Flow diagram of search strategy.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies. Blank spaces in tables indicated that study authors did not report the review outcome.
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies. Blank spaces in tables indicated that study authors did not report the review outcome.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study. Blank spaces in tables indicate that study authors did not report the review outcome.
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study. Blank spaces in tables indicate that study authors did not report the review outcome.

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 1 In‐hospital mortality.
Figures and Tables -
Analysis 1.1

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 1 In‐hospital mortality.

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 2 Mortality at 30 days.
Figures and Tables -
Analysis 1.2

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 2 Mortality at 30 days.

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 3 Mortality at 90 days.
Figures and Tables -
Analysis 1.3

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 3 Mortality at 90 days.

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 4 Aspiration.
Figures and Tables -
Analysis 1.4

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 4 Aspiration.

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 5 Pneumothorax.
Figures and Tables -
Analysis 1.5

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 5 Pneumothorax.

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 6 Hyperglycaemia.
Figures and Tables -
Analysis 1.6

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 6 Hyperglycaemia.

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 7 Vomiting.
Figures and Tables -
Analysis 1.7

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 7 Vomiting.

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 8 Diarrhoea.
Figures and Tables -
Analysis 1.8

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 8 Diarrhoea.

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 9 Abdominal distension.
Figures and Tables -
Analysis 1.9

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 9 Abdominal distension.

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 10 Sepsis.
Figures and Tables -
Analysis 1.10

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 10 Sepsis.

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 11 Pneumonia.
Figures and Tables -
Analysis 1.11

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 11 Pneumonia.

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 12 Intra‐abdominal infection.
Figures and Tables -
Analysis 1.12

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 12 Intra‐abdominal infection.

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 13 Wound infection.
Figures and Tables -
Analysis 1.13

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 13 Wound infection.

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 14 Urinary tract infection.
Figures and Tables -
Analysis 1.14

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 14 Urinary tract infection.

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 15 In‐hospital mortality: gastrointestinal (GI) medical/surgical vs non‐GI medical/surgical.
Figures and Tables -
Analysis 1.15

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 15 In‐hospital mortality: gastrointestinal (GI) medical/surgical vs non‐GI medical/surgical.

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 16 Mortality at 30 days: GI medical/surgical vs non‐GI medical/surgical.
Figures and Tables -
Analysis 1.16

Comparison 1 Enteral (EN) versus parenteral nutrition (PN), Outcome 16 Mortality at 30 days: GI medical/surgical vs non‐GI medical/surgical.

Comparison 2 Enteral (EN) versus combined EN and parenteral nutrition (PN), Outcome 1 In‐hospital mortality.
Figures and Tables -
Analysis 2.1

Comparison 2 Enteral (EN) versus combined EN and parenteral nutrition (PN), Outcome 1 In‐hospital mortality.

Comparison 2 Enteral (EN) versus combined EN and parenteral nutrition (PN), Outcome 2 Mortality at 30 days.
Figures and Tables -
Analysis 2.2

Comparison 2 Enteral (EN) versus combined EN and parenteral nutrition (PN), Outcome 2 Mortality at 30 days.

Comparison 2 Enteral (EN) versus combined EN and parenteral nutrition (PN), Outcome 3 Mortality at 90 days.
Figures and Tables -
Analysis 2.3

Comparison 2 Enteral (EN) versus combined EN and parenteral nutrition (PN), Outcome 3 Mortality at 90 days.

Comparison 2 Enteral (EN) versus combined EN and parenteral nutrition (PN), Outcome 4 Feeding tube obstruction.
Figures and Tables -
Analysis 2.4

Comparison 2 Enteral (EN) versus combined EN and parenteral nutrition (PN), Outcome 4 Feeding tube obstruction.

Comparison 2 Enteral (EN) versus combined EN and parenteral nutrition (PN), Outcome 5 Diarrhoea.
Figures and Tables -
Analysis 2.5

Comparison 2 Enteral (EN) versus combined EN and parenteral nutrition (PN), Outcome 5 Diarrhoea.

Comparison 2 Enteral (EN) versus combined EN and parenteral nutrition (PN), Outcome 6 Pneumonia.
Figures and Tables -
Analysis 2.6

Comparison 2 Enteral (EN) versus combined EN and parenteral nutrition (PN), Outcome 6 Pneumonia.

Comparison 2 Enteral (EN) versus combined EN and parenteral nutrition (PN), Outcome 7 Wound infection.
Figures and Tables -
Analysis 2.7

Comparison 2 Enteral (EN) versus combined EN and parenteral nutrition (PN), Outcome 7 Wound infection.

Comparison 2 Enteral (EN) versus combined EN and parenteral nutrition (PN), Outcome 8 Bloodstream infection.
Figures and Tables -
Analysis 2.8

Comparison 2 Enteral (EN) versus combined EN and parenteral nutrition (PN), Outcome 8 Bloodstream infection.

Comparison 2 Enteral (EN) versus combined EN and parenteral nutrition (PN), Outcome 9 Urinary tract infection.
Figures and Tables -
Analysis 2.9

Comparison 2 Enteral (EN) versus combined EN and parenteral nutrition (PN), Outcome 9 Urinary tract infection.

Comparison 2 Enteral (EN) versus combined EN and parenteral nutrition (PN), Outcome 10 Airway infection.
Figures and Tables -
Analysis 2.10

Comparison 2 Enteral (EN) versus combined EN and parenteral nutrition (PN), Outcome 10 Airway infection.

Summary of findings for the main comparison. Enteral versus parenteral nutrition for adults in the intensive care unit

Enteral versus parenteral nutrition for adults in the intensive care unit

Patient or population: critically ill adults admitted to the ICU for trauma, emergency, or surgical care; population excluded people with acute pancreatitis
Setting: intensive care units in: Brazil, China, Germany, Iran, Italy, Turkey, UK, and USA
Intervention: EN
Comparison: PN

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Certainty of the evidence
(GRADE)

Risk with EN

Risk with PN

Mortality

In‐hospital mortality

RR 1.19
(0.80 to 1.77)

361
(6 studies)

⊕⊕⊝⊝
Lowa

Study population

229 per 1000
(154 to 340)

192 per 1000

Mortality within 30 days

RR 1.02 (0.92 to 1.13)

3148
(11 studies)

⊕⊕⊝⊝
Lowb

Study population

304 per 1000
(274 to 336)

298 per 1000

Mortality within 90 days

RR 1.06
(0.95 to 1.17)

2461
(3 studies)

⊕⊝⊝⊝
Very lowc

Study population

393 per 1000
(352 to 434)

371 per 1000

Mortality within 180 days

RR 0.33 (0.04 to 2.97)

46
(1 study)

⊕⊝⊝⊝
Very lowd

Study population

130 per 1000

43 per 1000 (5 in 387)

Number of ICU‐free days up to day 28

Not measured

Number of ventilator‐free days up to day 28

Mean number of ventilator‐free days: 14.2 (SD ± 12.2)

Mean difference 0 days (0.97 fewer to 0.97 more)

N/A

2388
(1 study)

⊕⊝⊝⊝
Very lowd

Adverse events: aspiration (as reported by study authors at end of study follow‐up period)

Study population

RR 1.53
(0.46 to 5.03)

2437
(2 studies)

⊕⊝⊝⊝
Very lowe

5 per 1000
(2 to 17)

3 per 1000

Adverse events: sepsis (as reported by study authors at end of study follow‐up period)

Study population

RR 0.59 (0.37 to 0.95)

361
(7 studies)

⊕⊕⊝⊝
Lowf

123 per 1000
(77 to 199)

209 per 1000

Adverse events: pneumonia (as reported by study authors at end of study follow‐up period)

Study population

RR 1.10 (0.82 to 1.48)

415
(7 studies)

⊕⊕⊝⊝
Lowf

314 per 1000
(234 to 423)

268 per 1000

Adverse events: vomiting (as reported by study authors at end of study follow‐up period)

Study population

RR 3.42
(1.15 to 10.16)

2525
(3 studies)

⊕⊝⊝⊝
Very lowg

11 per 1000
(4 to 32)

3 per 1000

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; EN: enteral nutrition; ICU: intensive care unit; N/A: not applicable; PN: parenteral nutrition; RR: risk ratio; SD: standard deviation.

GRADE Working Group grades of evidence
High: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

aAll studies had a high risk of performance bias; downgraded one level for study limitations. Studies included a variety of primary diagnoses and evidence was less direct; downgraded one level for indirectness.

bAll studies had a high risk of performance bias; downgraded one level for study limitations. Studies included a variety of primary diagnoses and study designs and evidence were less direct; downgraded one level for indirectness.

cAll studies had a high risk of performance bias; downgraded one level for study limitations. Studies included a variety of primary diagnoses and study designs and evidence were less direct; downgraded one level for indirectness. Few studies and one included study had a large number of participants relative to other included studies; downgraded one level for imprecision.

dData from only one study that had a high risk of performance bias; downgraded one level for study limitations and two levels for imprecision.

eAll studies had a high risk of performance bias; downgraded one level for study limitations. Studies included a variety of primary diagnoses and evidence was less direct; downgraded one level for indirectness. Few studies and one included study had a large number of participants relative to other included studies; downgraded one level for imprecision.

fAll studies had a high risk of performance bias; downgraded one level for study limitations. Studies included a variety of primary diagnoses and evidence was less direct; downgraded one level for indirectness.

gAll studies had a high risk of performance bias; downgraded one level for study limitations. Studies included a variety of primary diagnoses and study designs and evidence were less direct; downgraded one level for indirectness. Few studies, with very few events, and one included study had a large number of participants relative to other included studies; downgraded one level for imprecision.

Figures and Tables -
Summary of findings for the main comparison. Enteral versus parenteral nutrition for adults in the intensive care unit
Summary of findings 2. Enteral versus enteral and parenteral nutrition for adults in the intensive care unit

Enteral versus enteral and parenteral nutrition for adults in the intensive care unit

Patient or population: critically ill adults admitted to the ICU for trauma, emergency, or post‐surgical care; population excludes participants with acute pancreatitis
Setting: intensive care units in: France, Italy, Switzerland, Turkey, and USA
Intervention: EN
Comparison: EN + PN

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Certainty of the evidence
(GRADE)

Risk with EN

Risk with EN + PN

Mortality

In‐hospital mortality

RR 0.99 (0.84 to 1.16)

5111
(5 studies)

⊕⊕⊝⊝
Lowa

Study population

106 per 1000
(90 to 124)

107 per 1000

Mortality within 30 days

RR 1.64 (1.06 to 2.54)

409
(3 studies)

⊕⊝⊝⊝
Very lowb

Study population

216 per 1000
(140 to 335)

132 per 1000

Mortality within 90 days

RR 1.00 (0.86 to 1.18)

4760

(2 studies)

⊕⊕⊝⊝
Lowc

Study population

115 per 1000

(99 to 135)

115 per 1000

Mortality within 180 days

RR 1.00
(0.65 to 1.55)

120

(1 RCT)

⊕⊝⊝⊝
Very lowd

Study population

400 per 1000

(260 to 620)

400 per 1000

Number of ICU‐free days up to day 28

Not measured

Number of ventilator‐free days up to day 28

Not measured

Adverse events: aspiration (as reported by study authors at end of study follow‐up period)

Not measured

Adverse events: sepsis (as reported by study authors at end of study follow‐up period)

Not measured

Adverse events: pneumonia (as reported by study authors at end of study follow‐up period)

350 per 1000

(228 to 538)

250 per 1000

RR 1.40 (0.91 to 2.15)

205

(2 studies)

⊕⊝⊝⊝

Very lowd

Adverse events: vomiting (as reported by study authors at end of study follow‐up period)

Not measured

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; EN: enteral nutrition; ICU: intensive care unit; PN: parenteral nutrition; RCT: randomized controlled trial; RR: risk ratio.

GRADE Working Group grades of evidence
High: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

aAll studies had high risk of performance bias; downgraded one level for study limitations. Studies included a variety of primary diagnoses and evidence was less direct; downgraded one level for indirectness.

bAll studies had high risk of performance bias; downgraded one level for study limitations. Studies included a variety of primary diagnoses and evidence was less direct; downgraded one level for indirectness. Few studies with increased risk of imprecision; downgraded one level.

cBoth studies had high risk of performance bias; downgraded one level for study limitations. Studies included a variety of primary diagnoses and evidence was less direct; downgraded one level for indirectness.

dData from only one study that had a high risk of performance bias; downgraded one level for study limitations and two levels for imprecision.

Figures and Tables -
Summary of findings 2. Enteral versus enteral and parenteral nutrition for adults in the intensive care unit
Table 1. Adverse events for single studies: enteral nutrition versus parenteral nutrition

Study ID

Description of event

EN group (n/N)

PN group (n/N)

Mechanical events

Adams 1986

Clogged jejunostomy tube

9/23

N/A

Disconnected line

N/A

1/23

Line eroded into right upper lobe bronchus

N/A

1/23

Malfunctioned line

N/A

7/23

Dunham 1994

Transpyloric tube occlusion

2/12

0/15

Failure to intubate

0/12

0/15

Withdrawal of tube by participant

1/12

N/A

Metabolic events

Adams 1986

Hepatic failure

1/23

1/23

Acute renal failure

1/23

1/23

Pancreatitis

2/23

1/23

Fan 2016

Hypoproteinaemia

22/40

32/40

Harvey 2014

Electrolyte disturbance

5/1197

8/1191

Gastrointestinal events

Adams 1986

Nausea, cramps, bloating

19/23

16/23

Gastrointestinal bleeding

0/23

0/23

Dunham 1994

Gastric reflux

0/12

0/15

Ileus

1/12

0/15

Small bowel ileus

0/12

1/15

Fan 2016

Stress ulcer

7/40

19/40

Harvey 2014

Elevated liver enzymes

7/1197

3/1191

Jaundice

1/1197

1/1191

Ischaemic bowel

0/1197

1/1191

Xi 2014

Anastomotic leak

2/22

6/23

Infective events

Adams 1986

Persistent fever without obvious cause

1/23

5/23

Altintas 2011

Catheter infection

2/30

4/41

Borzotta 1994

Meningitis

2/28

0/21

Sinusitis

3/28

6/21

Bronchitis

6/28

6/28

Clostridium difficile

2/28

4/21

Peritonitis

0/28

1/21

Fan 2016

Intracranial infection

7/40

13/40

Pyaemia

3/40

19/40

Gencer 2010

Pulmonary infection

2/30

2/30

Kudsk 1992

Empyema

1/51

4/45

Young 1987

Aspiration pneumonia

9/28

3/23

Infection (type of infection not described)

5/28

4/23

EN: enteral nutrition; n: number of participants with an event; N: total number randomized to group; N/A: not applicable; PN: parenteral nutrition.

Figures and Tables -
Table 1. Adverse events for single studies: enteral nutrition versus parenteral nutrition
Table 2. Adverse events for single studies: enteral nutrition versus enteral nutrition and parenteral nutrition

Study ID

Description of event

EN group (n/N)

EN + PN group (n/N)

Mechanical events

Casaer 2011

CVC obstruction

9/2328

15/2312

Nasal bleeding

18/2328

14/2312

Pneumohaemothorax after CVC placement

0/2328

2/2312

Subclavian artery puncture

0/2328

2/2312

Dunham 1994

Withdrawal of tube

1/12

0/10

Failure to intubate

0/12

2/10

Metabolic events

Fan 2016

Hypoproteinaemia

22/40

7/40

Gastrointestinal events

Casaer 2011

Vomiting or aspiration

284/2328

295/2312

Dunham 1994

Gastric reflux

0/12

2/10

Fan 2016

Stress ulcer

7/40

9/40

infective events

Fan 2016

Pyemia

3/40

10/40

Intracranial infection

7/40

5/40

Wischmeyer 2017

Catheter bloodstream infection

0/73

7/52

Intra‐abdominal infection

0/73

4/52

Upper urinary tract infection

0/73

1/52

Surgical deep infection

0/73

1/52

CVC: central venous catheter; EN: enteral nutrition; EN + PN: combined enteral and parenteral nutrition; n: number of participants with an event; N: total number randomized to group.

Figures and Tables -
Table 2. Adverse events for single studies: enteral nutrition versus enteral nutrition and parenteral nutrition
Comparison 1. Enteral (EN) versus parenteral nutrition (PN)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 In‐hospital mortality Show forest plot

6

361

Risk Ratio (M‐H, Fixed, 95% CI)

1.19 [0.80, 1.77]

2 Mortality at 30 days Show forest plot

11

3148

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.92, 1.13]

3 Mortality at 90 days Show forest plot

3

2461

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.95, 1.17]

4 Aspiration Show forest plot

2

2437

Risk Ratio (M‐H, Fixed, 95% CI)

1.53 [0.46, 5.03]

5 Pneumothorax Show forest plot

2

2437

Risk Ratio (M‐H, Fixed, 95% CI)

1.46 [0.19, 11.22]

6 Hyperglycaemia Show forest plot

2

2437

Risk Ratio (M‐H, Fixed, 95% CI)

0.57 [0.35, 0.93]

7 Vomiting Show forest plot

3

2525

Risk Ratio (M‐H, Fixed, 95% CI)

3.42 [1.15, 10.16]

8 Diarrhoea Show forest plot

6

363

Risk Ratio (M‐H, Fixed, 95% CI)

2.17 [1.72, 2.75]

9 Abdominal distension Show forest plot

3

2505

Risk Ratio (M‐H, Fixed, 95% CI)

1.53 [0.34, 6.96]

10 Sepsis Show forest plot

7

361

Risk Ratio (M‐H, Fixed, 95% CI)

0.59 [0.37, 0.95]

11 Pneumonia Show forest plot

7

415

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.82, 1.48]

12 Intra‐abdominal infection Show forest plot

3

202

Risk Ratio (M‐H, Fixed, 95% CI)

0.26 [0.07, 0.89]

13 Wound infection Show forest plot

3

155

Risk Ratio (M‐H, Fixed, 95% CI)

1.45 [0.55, 3.82]

14 Urinary tract infection Show forest plot

3

160

Risk Ratio (M‐H, Fixed, 95% CI)

1.48 [0.65, 3.40]

15 In‐hospital mortality: gastrointestinal (GI) medical/surgical vs non‐GI medical/surgical Show forest plot

6

361

Risk Ratio (M‐H, Fixed, 95% CI)

1.19 [0.80, 1.77]

15.1 GI medical/surgical

1

98

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.06, 13.74]

15.2 Non‐GI medical/surgical

5

263

Risk Ratio (M‐H, Fixed, 95% CI)

1.20 [0.80, 1.79]

16 Mortality at 30 days: GI medical/surgical vs non‐GI medical/surgical Show forest plot

10

3068

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.93, 1.14]

16.1 GI medical/surgical

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.12, 3.71]

16.2 Non‐GI medical/surgical

9

3008

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.93, 1.15]

Figures and Tables -
Comparison 1. Enteral (EN) versus parenteral nutrition (PN)
Comparison 2. Enteral (EN) versus combined EN and parenteral nutrition (PN)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 In‐hospital mortality Show forest plot

5

5111

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.84, 1.16]

2 Mortality at 30 days Show forest plot

3

409

Risk Ratio (M‐H, Fixed, 95% CI)

1.64 [1.06, 2.54]

3 Mortality at 90 days Show forest plot

2

4760

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.86, 1.18]

4 Feeding tube obstruction Show forest plot

2

4662

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.70, 1.32]

5 Diarrhoea Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

6 Pneumonia Show forest plot

2

205

Risk Ratio (M‐H, Fixed, 95% CI)

1.40 [0.91, 2.15]

7 Wound infection Show forest plot

2

4765

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.50, 0.92]

8 Bloodstream infection Show forest plot

2

4765

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.66, 1.01]

9 Urinary tract infection Show forest plot

3

4885

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.65, 1.17]

10 Airway infection Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figures and Tables -
Comparison 2. Enteral (EN) versus combined EN and parenteral nutrition (PN)