Enteral Nutritional Supplementation With Key Nutrients in... : Annals of Surgery (original) (raw)

Review

Enteral Nutritional Supplementation With Key Nutrients in Patients With Critical Illness and Cancer

A Meta-Analysis of Randomized Controlled Clinical Trials

Heys, Steven D. MD, PhD*†; Walker, Leslie G. PhD*†; Smith, Ian MBChB†; Eremin, Oleg MD, FRACS†

From the *Surgical Nutrition and Metabolism Unit and the †Department of Surgery, University of Aberdeen, Aberdeen, Scotland, United Kingdom

Correspondence: Steven D. Heys, MD, PhD, Surgical Nutrition and Metabolism Unit, Department of Surgery, University Medical Buildings, Foresterhill, Aberdeen, Scotland AB9 2ZD, United Kingdom.

Accepted for publication December 11, 1998.

Abstract

Objective

To conduct a meta-analysis of 11 randomized controlled trials comparing enteral nutritional support supplemented with key nutrients versus standard enteral nutritional support to determine effects on morbidity and mortality rates and hospital stay.

Background Data

Recent studies have shown that malnutrition occurs in up to 30% of patients undergoing gastrointestinal surgery, resulting in an increased risk of postoperative complications and death. With the realization that key nutrients can modulate inflammatory, metabolic, and immune processes, enteral nutritional regimens (supplemented with large amounts of key nutrients) have been developed for clinical use.

Methods

Eleven prospective, randomized controlled trials evaluating 1009 patients treated with combinations of key nutrients (Impact, Immun-Aid) were evaluated. Outcome measures examined were the incidences of pneumonia, infectious complications, and death, and length of hospital stay. Meta-analyses were undertaken to obtain the odds ratio and 95% confidence interval for incidences of infectious complications, pneumonia, and death, and the weighted mean difference and 95% confidence interval for length of hospital stay.

Results

The provision of nutritional support supplemented with key nutrients to patients with critical illness resulted in a decrease in infectious complications when compared with patients receiving standard nutritional support and a significant reduction in overall hospital stay. Similar results were documented in patients with gastrointestinal cancer. However, there were no differences between patient groups for either pneumonia or death.

Conclusions

This meta-analysis has demonstrated that nutritional support supplemented with key nutrients results in a significant reduction in the risk of developing infectious complications and reduces the overall hospital stay in patients with critical illness and in patients with gastrointestinal cancer. However, there is no effect on death. These data have important implications for the management of such patients.