Protein delivery and clinical outcomes in the critically ill: a systematic review and meta-analysis
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作者:
Davies, Michael L.
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机构:
Royal Adelaide Hosp, Crit Care Serv, Adelaide, SA, AustraliaRoyal Adelaide Hosp, Crit Care Serv, Adelaide, SA, Australia
Davies, Michael L.
[1
]
Chapple, Lee-Anne S.
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机构:
Univ Adelaide, Discipline Acute Care Med, Adelaide, SA, AustraliaRoyal Adelaide Hosp, Crit Care Serv, Adelaide, SA, Australia
Chapple, Lee-Anne S.
[2
]
Chapman, Marianne J.
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机构:
Royal Adelaide Hosp, Crit Care Serv, Adelaide, SA, Australia
Univ Adelaide, Discipline Acute Care Med, Adelaide, SA, AustraliaRoyal Adelaide Hosp, Crit Care Serv, Adelaide, SA, Australia
Chapman, Marianne J.
[1
,2
]
Moran, John L.
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机构:
Univ Adelaide, Discipline Acute Care Med, Adelaide, SA, Australia
Queen Elizabeth Hosp, Dept Intens Care Med, Adelaide, SA, AustraliaRoyal Adelaide Hosp, Crit Care Serv, Adelaide, SA, Australia
Moran, John L.
[2
,3
]
Peake, Sandra L.
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机构:
Univ Adelaide, Discipline Acute Care Med, Adelaide, SA, Australia
Queen Elizabeth Hosp, Dept Intens Care Med, Adelaide, SA, AustraliaRoyal Adelaide Hosp, Crit Care Serv, Adelaide, SA, Australia
Peake, Sandra L.
[2
,3
]
机构:
[1] Royal Adelaide Hosp, Crit Care Serv, Adelaide, SA, Australia
[2] Univ Adelaide, Discipline Acute Care Med, Adelaide, SA, Australia
[3] Queen Elizabeth Hosp, Dept Intens Care Med, Adelaide, SA, Australia
Objectives: Protein is a fundamental component of critical care nutrition, but there has been uncertainty about the optimal amount. We undertook this systematic review and meta-analysis to examine the relationship between delivered protein and mortality in randomised controlled trials (RCTs) of nutritional interventions involving critically ill adults. Secondary outcomes included the effect of protein dose on lengths of stay, mechanical ventilation and incidence of infections. Methods: We reviewed the relevant English-language literature published between 1966 and 2015 and identified RCTs comparing different strategies of nutritional support lasting at least 48 hours in critically ill adults. Articles were included if mortality was reported and the difference in delivered protein between interventions was significant (P < 0.05). We calculated summary estimates for mortality as odds ratios (ORs) with 95% confidence intervals (CIs) using a random-effects estimator, and we used meta-regression to assess the effect of delivered protein on mortality. Results: From 3016 assessed records, 357 full-text articles were reviewed and 14 studies, investigating various interventions and routes of nutrition and comprising 3238 patients, were included. The mean protein delivered was 42.95 g/day (SD, 20.45 g/day) or 0.67 g//kg/day (SD, 0.38 g/kg/day) in patients receiving less protein, and 67.15 g/day (SD, 28.47 g/day) or 1..02 g/kg/day (SD, 0.42 g/kg/day) in the higher protein group. Provision of less protein did not influence mortality risk (pooled OR, 0.935; 95% CI, 0.716-1.219; P = 0.618; /(2) = 48.2%). Meta-regression analysis did not show a relationship between mean daily protein delivered and mortality (P = 0.433; /(2) = 50:18%). There were no differences between groups in any secondary outcomes. Conclusions: Delivery of varying amounts of nutritional protein was not associated with any effect on mortality.
机构:
Stollery Childrens Hosp, Dept Pediat, Div Pediat Crit Care, Edmonton, AB, CanadaUniv Alberta, Fac Med & Dent, Dept Crit Care Med, Room 2-124E,Clin Sci Bldg,8440 112th St NW, Edmonton, AB T6G 2B7, Canada
Alobaidi, Rashid
Morgan, Catherine
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机构:
Univ Alberta, Fac Med & Dent, Dept Pediat, Div Nephrol, Edmonton, AB, CanadaUniv Alberta, Fac Med & Dent, Dept Crit Care Med, Room 2-124E,Clin Sci Bldg,8440 112th St NW, Edmonton, AB T6G 2B7, Canada
Morgan, Catherine
Basu, Rajit K.
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机构:
Emory Univ, Sch Med, Dept Pediat, Childrens Healthcare Atlanta,Div Crit Care Med, Atlanta, GA USAUniv Alberta, Fac Med & Dent, Dept Crit Care Med, Room 2-124E,Clin Sci Bldg,8440 112th St NW, Edmonton, AB T6G 2B7, Canada
Basu, Rajit K.
Stenson, Erin
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机构:
Cincinnati Childrens Hosp Med Ctr, Dept Pediat, Div Crit Care Med, Cincinnati, OH 45229 USAUniv Alberta, Fac Med & Dent, Dept Crit Care Med, Room 2-124E,Clin Sci Bldg,8440 112th St NW, Edmonton, AB T6G 2B7, Canada
Stenson, Erin
Featherstone, Robin
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机构:
Univ Alberta, Fac Med & Dent, Dept Pediat, ARCHE,Alberta Strategy Patient Oriented Res SPOR, Edmonton, AB, CanadaUniv Alberta, Fac Med & Dent, Dept Crit Care Med, Room 2-124E,Clin Sci Bldg,8440 112th St NW, Edmonton, AB T6G 2B7, Canada
Featherstone, Robin
Majumdar, Sunlit R.
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机构:
Univ Alberta, Fac Med & Dent, Dept Med, Edmonton, AB, CanadaUniv Alberta, Fac Med & Dent, Dept Crit Care Med, Room 2-124E,Clin Sci Bldg,8440 112th St NW, Edmonton, AB T6G 2B7, Canada
Majumdar, Sunlit R.
Bagshaw, Sean M.
论文数: 0引用数: 0
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机构:
Univ Alberta, Fac Med & Dent, Dept Crit Care Med, Room 2-124E,Clin Sci Bldg,8440 112th St NW, Edmonton, AB T6G 2B7, CanadaUniv Alberta, Fac Med & Dent, Dept Crit Care Med, Room 2-124E,Clin Sci Bldg,8440 112th St NW, Edmonton, AB T6G 2B7, Canada
机构:
Charles Univ Prague, Fac Med 3, Dept Anaesthesia & Intens Care, Prague, Czech Republic
FNKV Univ Hosp, Prague, Czech RepublicCharles Univ Prague, Fac Med 3, Dept Anaesthesia & Intens Care, Prague, Czech Republic
Jiroutkova, Katerina
Krajcova, Adela
论文数: 0引用数: 0
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机构:
Charles Univ Prague, Fac Med 3, Dept Anaesthesia & Intens Care, Prague, Czech Republic
FNKV Univ Hosp, Prague, Czech RepublicCharles Univ Prague, Fac Med 3, Dept Anaesthesia & Intens Care, Prague, Czech Republic
Krajcova, Adela
Puthucheary, Zudin
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机构:
Queen Mary Univ London, William Harvey Res Inst, Barts & London Sch Med & Dent, London, EnglandCharles Univ Prague, Fac Med 3, Dept Anaesthesia & Intens Care, Prague, Czech Republic
Puthucheary, Zudin
Duska, Frantisek
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机构:
Charles Univ Prague, Fac Med 3, Dept Anaesthesia & Intens Care, Prague, Czech Republic
FNKV Univ Hosp, Prague, Czech RepublicCharles Univ Prague, Fac Med 3, Dept Anaesthesia & Intens Care, Prague, Czech Republic
机构:
Univ Republ UdelaR, Fac Med, Univ Hosp, Dept Crit Care,Intens Care Unit,Hosp Clin, Ave Italia,14th Floor, Montevideo 11600, UruguayUniv Republ UdelaR, Fac Med, Univ Hosp, Dept Crit Care,Intens Care Unit,Hosp Clin, Ave Italia,14th Floor, Montevideo 11600, Uruguay
Manzanares, William
Lemieux, Margot
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Kingston Gen Hosp, Clin Evaluat Res Unit, Kingston, ON, CanadaUniv Republ UdelaR, Fac Med, Univ Hosp, Dept Crit Care,Intens Care Unit,Hosp Clin, Ave Italia,14th Floor, Montevideo 11600, Uruguay
Lemieux, Margot
Elke, Gunnar
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机构:
Univ Med Ctr Schleswig Holstein, Dept Anesthesiol & Intens Care Med, Campus Kiel, Kiel, GermanyUniv Republ UdelaR, Fac Med, Univ Hosp, Dept Crit Care,Intens Care Unit,Hosp Clin, Ave Italia,14th Floor, Montevideo 11600, Uruguay
机构:
Sherbrooke Univ Hosp, Fac Med & Hlth Sci, Dept Anesthesiol & Reanimat, Sherbrooke, PQ, CanadaSherbrooke Univ Hosp, Fac Med & Hlth Sci, Dept Anesthesiol & Reanimat, Sherbrooke, PQ, Canada
Langlois, Pascal L.
Manzanares, William
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Univ Republica, Univ Hosp, Fac Med, Dept Crit Care,Intens Care Unit, Montevideo, UruguaySherbrooke Univ Hosp, Fac Med & Hlth Sci, Dept Anesthesiol & Reanimat, Sherbrooke, PQ, Canada
Manzanares, William
Adhikari, Neill K. J.
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Univ Toronto, Sunnybrook Hlth Sci Ctr, Interdept Div Crit Care Med, Dept Crit Care Med, Toronto, ON, CanadaSherbrooke Univ Hosp, Fac Med & Hlth Sci, Dept Anesthesiol & Reanimat, Sherbrooke, PQ, Canada
Adhikari, Neill K. J.
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机构:
Lamontagne, Francois
Stoppe, Christian
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Univ Hosp Rhein Westfalische TH Aachen, Dept Intens Care Med, Aachen, GermanySherbrooke Univ Hosp, Fac Med & Hlth Sci, Dept Anesthesiol & Reanimat, Sherbrooke, PQ, Canada
Stoppe, Christian
Hill, Aileen
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机构:
Univ Hosp Rhein Westfalische TH Aachen, Dept Intens Care Med, Aachen, GermanySherbrooke Univ Hosp, Fac Med & Hlth Sci, Dept Anesthesiol & Reanimat, Sherbrooke, PQ, Canada
Hill, Aileen
Heyland, Daren K.
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机构:
Kingston Gen Hosp, Clin Evaluat Res Unit, Kingston, ON, Canada
Queens Univ, Dept Crit Care, Kingston, ON, CanadaSherbrooke Univ Hosp, Fac Med & Hlth Sci, Dept Anesthesiol & Reanimat, Sherbrooke, PQ, Canada
机构:
Univ Stellenbosch, Div Human Nutr, ZA-7600 Stellenbosch, South Africa
Tygerberg Acad Hosp, Tygerberg, South AfricaUniv Stellenbosch, Div Human Nutr, ZA-7600 Stellenbosch, South Africa
Visser, Janicke
Labadarios, Demetre
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机构:Univ Stellenbosch, Div Human Nutr, ZA-7600 Stellenbosch, South Africa
机构:
Univ Queensland, Sch Med, Burns Trauma & Crit Care Res Ctr, Brisbane, Qld, AustraliaUniv Queensland, Sch Med, Burns Trauma & Crit Care Res Ctr, Brisbane, Qld, Australia
Kayambu, Geetha
Boots, Robert
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机构:
Univ Queensland, Sch Med, Burns Trauma & Crit Care Res Ctr, Brisbane, Qld, Australia
Royal Brisbane & Womens Hosp, Dept Intens Care Med, Brisbane, Qld, AustraliaUniv Queensland, Sch Med, Burns Trauma & Crit Care Res Ctr, Brisbane, Qld, Australia
Boots, Robert
Paratz, Jennifer
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Univ Queensland, Sch Med, Burns Trauma & Crit Care Res Ctr, Brisbane, Qld, AustraliaUniv Queensland, Sch Med, Burns Trauma & Crit Care Res Ctr, Brisbane, Qld, Australia