Ronald L Koretz1, Timothy O Lipman2. 1. Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA. Electronic address: rkoretz@msn.com. 2. Gastroenterology, Hepatology, and Nutrition Section, Veterans Affairs Medical Center, Washington, D.C., USA. Electronic address: Timothy.Lipman@va.gov.
Abstract
BACKGROUND: Randomized trials suggest that early enteral nutrition is beneficial in critically ill adults. However, methodologic bias can overestimate benefit. OBJECTIVE: To assess the potential effect of methodologic bias on these trials. STUDY DESIGN: Systematic review and meta-analysis. DATA SOURCE: Randomized trials identified in electronic searches of PUBMED, EMBASE, and the Cochrane Library, and in various handsearches. METHODS: The primary (mortality, morbidity) and secondary (time on ventilator or in intensive care unit/hospital, cost) outcomes were abstracted from each identified trial comparing early enteral nutrition to no/delayed enteral nutrition. Each trial was assessed for six domains of methodologic bias (sequence generation, allocation concealment, blinding, intention-to-treat, selective outcome reporting, other). No low risk of bias trial (adequate in all six domains) was identified, so such trials could not be compared to the others. Instead, meta-analyses of trials with more or fewer risks were compared in the following ways: adequate methodology to deal with ≥3 or ≤2 domains; Jadad scores ≥3 or ≤2; adequate versus not adequate for each domain. DATA SYNTHESIS: In the 15 identified trials, early enteral nutrition appeared to improve mortality and infectious morbidity. Mortality benefit was observed only in trials with more risks of bias; infectious morbidity benefit was observed in some analyses of trials with fewer bias risks. LIMITATIONS: Small numbers of trials and missing information. CONCLUSIONS: The benefits attributed to early enteral nutrition were either seen only in trials with high risks of bias or may result from residual risks of bias.
BACKGROUND: Randomized trials suggest that early enteral nutrition is beneficial in critically ill adults. However, methodologic bias can overestimate benefit. OBJECTIVE: To assess the potential effect of methodologic bias on these trials. STUDY DESIGN: Systematic review and meta-analysis. DATA SOURCE: Randomized trials identified in electronic searches of PUBMED, EMBASE, and the Cochrane Library, and in various handsearches. METHODS: The primary (mortality, morbidity) and secondary (time on ventilator or in intensive care unit/hospital, cost) outcomes were abstracted from each identified trial comparing early enteral nutrition to no/delayed enteral nutrition. Each trial was assessed for six domains of methodologic bias (sequence generation, allocation concealment, blinding, intention-to-treat, selective outcome reporting, other). No low risk of bias trial (adequate in all six domains) was identified, so such trials could not be compared to the others. Instead, meta-analyses of trials with more or fewer risks were compared in the following ways: adequate methodology to deal with ≥3 or ≤2 domains; Jadad scores ≥3 or ≤2; adequate versus not adequate for each domain. DATA SYNTHESIS: In the 15 identified trials, early enteral nutrition appeared to improve mortality and infectious morbidity. Mortality benefit was observed only in trials with more risks of bias; infectious morbidity benefit was observed in some analyses of trials with fewer bias risks. LIMITATIONS: Small numbers of trials and missing information. CONCLUSIONS: The benefits attributed to early enteral nutrition were either seen only in trials with high risks of bias or may result from residual risks of bias.
Authors: Michael T Vest; Paul Kolm; James Bowen; Jillian Trabulsi; Shannon L Lennon; Mary Shapero; Patty McGraw; James Halbert; Claudine Jurkovitz Journal: Am J Crit Care Date: 2018-03 Impact factor: 2.228
Authors: Sergey Efremov; Vladimir Lomivorotov; Christian Stoppe; Anna Shilova; Vladimir Shmyrev; Michail Deryagin; Alexander Karaskov Journal: Nutrients Date: 2017-11-20 Impact factor: 5.717