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The effect of indirect calorimetry guided isocaloric nutrition on mortality in critically ill patients—a systematic review and meta-analysis

European Journal of Clinical Nutrition volume 76, pages 5–15 (2022)Cite this article

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Abstract

Indirect calorimetry (IC)-guided nutrition might positively affect the clinical outcome of critically ill patients. In this systematic review and meta-analysis, our objective was to assess the benefit of isocaloric nutrition guided by IC, compared to hypocaloric nutrition, for critically ill patients admitted to the intensive care unit (ICU). We performed a systematic review of all randomized controlled trials published through January 2021, assessing the benefit of isocaloric nutrition guided by IC. The primary outcome was 28-day all-cause mortality. Secondary outcomes were ICU and 90-day all-cause mortality, rate of nosocomial infections, and adverse events. Four trials evaluating 1052 patients were included. Patients treated with isocaloric nutrition had a lower 28-day mortality rate (risk ratio (RR) 0.79, 95% confidence interval (CI) 0.63–0.99, P = 0.04). No between-group difference was found in ICU and 90-day mortality (RR 0.92, 95% CI 0.68–1.23, P = 0.56 and RR 0.88, 95% CI 0.72–1.07; P = 0.2, respectively) and in the rate of nosocomial infections (RR 1.15, 95% CI 0.77–1.72, P = 0.51). A pooled analysis of studies that evaluated the benefit of isocaloric nutrition guided by IC, for critically ill patients in the ICU, has shown reduced 28-day mortality. However, there was no difference in 90-day mortality and nosocomial infection rate.

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Authors and Affiliations

  1. Pulmonary Division, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel

    Barak Pertzov

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel

    Barak Pertzov, Yehonatan Menndel, Itai Bendavid, Ilya Kagan & Pierre Singer

  3. Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel

    Haggai Bar-Yoseph

  4. Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel

    Haggai Bar-Yoseph

  5. Department of Intensive Care, Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel

    Yehonatan Menndel, Itai Bendavid, Ilya Kagan & Pierre Singer

  6. Department of Medical Intensive Care, Rambam Health Care Campus Haifa, Haifa, Israel

    Yehuda Daniel Glass

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Contributions

BP, HB-Y, and JM have conducted the search for relevant articles. BP and HB-Y conducted the double extraction. PS, HB-Y, and BP have written the manuscript. IK, YDG, and IBD have revised the manuscript and assisted in statistical analysis

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Correspondence to Barak Pertzov.

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PS is the first author in two trials that were included in this review. There are no other conflicts of interest to declare.

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Pertzov, B., Bar-Yoseph, H., Menndel, Y. et al. The effect of indirect calorimetry guided isocaloric nutrition on mortality in critically ill patients—a systematic review and meta-analysis. Eur J Clin Nutr 76, 5–15 (2022). https://doi.org/10.1038/s41430-021-00919-0

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