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Abstract：
BACKGROUND: A unified clinical definition of feeding intolerance (FI) is urged for better management of enteral nutrition (EN) in critically ill patients. We aimed to identify optimum clinical FI definitions based on reported evidence.
METHODS: We searched clinical studies comparing FI with non-FI with a clear definition, summarized the evidence by random-effect meta-analyses, and rated the certainty of evidence by the Grading of Recommendations Assessment, Development and Evaluation frameworks.
RESULTS: Five thousand five hundred twenty-five records were identified, of which 26 eligible studies enrolled 25,189 adult patients. Most patient-centered outcomes were associated with FI overall. Low to very low certainty evidence established FI defined as large gastric residual volume (GRV) ≥ 250 ± 50 mL combined with any other gastrointestinal symptoms (GIS) had a significant association with high mortalities in particular all-cause hospital mortality (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.40-2.57), the incidence of pneumonia (OR 1.54, 95% CI 1.13-2.09) and prolonged length of hospital stay (mean difference 4.20, 95% CI 2.08-6.32), with a moderate hospital prevalence (41.49%, 95% CI 31.61-51.38%). 3-day enteral feeding (EF) delivered percentage < 80% had a moderate hospital prevalence (38.23%, 95% CI 24.88-51.58) but a marginally significant association with all-cause hospital mortality (OR 1.90, 95% CI 1.03-3.50).
CONCLUSIONS: In critically ill adult patients receiving EN, the large-GRV-centered GIS to define FI seemed to be superior to 3-day EF-insufficiency in terms of both close associations with all-cause hospital mortality and acceptable hospital prevalence (Registered PROSPERO: CRD42022326273).
BACKGROUND: The protocol for this review and meta-analysis was registered with PROSPERO: CRD42022326273. Registered 10 May 2022.
METHODS: We searched clinical studies comparing FI with non-FI with a clear definition, summarized the evidence by random-effect meta-analyses, and rated the certainty of evidence by the Grading of Recommendations Assessment, Development and Evaluation frameworks.
RESULTS: Five thousand five hundred twenty-five records were identified, of which 26 eligible studies enrolled 25,189 adult patients. Most patient-centered outcomes were associated with FI overall. Low to very low certainty evidence established FI defined as large gastric residual volume (GRV) ≥ 250 ± 50 mL combined with any other gastrointestinal symptoms (GIS) had a significant association with high mortalities in particular all-cause hospital mortality (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.40-2.57), the incidence of pneumonia (OR 1.54, 95% CI 1.13-2.09) and prolonged length of hospital stay (mean difference 4.20, 95% CI 2.08-6.32), with a moderate hospital prevalence (41.49%, 95% CI 31.61-51.38%). 3-day enteral feeding (EF) delivered percentage < 80% had a moderate hospital prevalence (38.23%, 95% CI 24.88-51.58) but a marginally significant association with all-cause hospital mortality (OR 1.90, 95% CI 1.03-3.50).
CONCLUSIONS: In critically ill adult patients receiving EN, the large-GRV-centered GIS to define FI seemed to be superior to 3-day EF-insufficiency in terms of both close associations with all-cause hospital mortality and acceptable hospital prevalence (Registered PROSPERO: CRD42022326273).
BACKGROUND: The protocol for this review and meta-analysis was registered with PROSPERO: CRD42022326273. Registered 10 May 2022.
摘要：
背景：对于喂养不耐受（FI）的一个统一的临床定义是为了更好地管理危重患者的肠内营养（EN）。我们旨在根据报告的证据确定最佳的临床FI定义。
方法：我们搜索了比较FI和非FI的临床研究，通过随机效应荟萃分析总结证据，并通过建议评级评估对证据的确定性进行评级，发展和评价框架。
结果：确定了五千五百二十五条记录，其中26项符合条件的研究纳入了25,189名成年患者。大多数以患者为中心的结果与整体FI相关。确定的低至极低的FI定义为大的胃残余体积（GRV）≥250±50mL与任何其他胃肠道症状（GIS）与高死亡率，特别是全因住院死亡率（比值比[OR]1.90，95％置信区间[CI]1.40-2.57），肺炎的发生率（OR1.54，95％CI1.13-2.09）和住院时间延长（平均差异4.20，95％CI2.08-6.32），医院患病率中等(41.49%，95%CI31.61-51.38%）。3天肠内喂养（EF）交付百分比<80％具有中度住院患病率（38.23％，95%CI24.88-51.58），但与全因住院死亡率有轻微显著关联（OR1.90，95%CI1.03-3.50）。
结论：在接受EN的危重成年患者中，在与全因医院死亡率和可接受的医院患病率密切相关方面,以大型GRV为中心的GIS定义FI似乎优于3天EF不全(注册PROSPERO:CRD42022326273).
背景：本综述和荟萃分析的方案已在PROSPERO：CRD42022326273注册。2022年5月10日注册。
方法：我们搜索了比较FI和非FI的临床研究，通过随机效应荟萃分析总结证据，并通过建议评级评估对证据的确定性进行评级，发展和评价框架。
结果：确定了五千五百二十五条记录，其中26项符合条件的研究纳入了25,189名成年患者。大多数以患者为中心的结果与整体FI相关。确定的低至极低的FI定义为大的胃残余体积（GRV）≥250±50mL与任何其他胃肠道症状（GIS）与高死亡率，特别是全因住院死亡率（比值比[OR]1.90，95％置信区间[CI]1.40-2.57），肺炎的发生率（OR1.54，95％CI1.13-2.09）和住院时间延长（平均差异4.20，95％CI2.08-6.32），医院患病率中等(41.49%，95%CI31.61-51.38%）。3天肠内喂养（EF）交付百分比<80％具有中度住院患病率（38.23％，95%CI24.88-51.58），但与全因住院死亡率有轻微显著关联（OR1.90，95%CI1.03-3.50）。
结论：在接受EN的危重成年患者中，在与全因医院死亡率和可接受的医院患病率密切相关方面,以大型GRV为中心的GIS定义FI似乎优于3天EF不全(注册PROSPERO:CRD42022326273).
背景：本综述和荟萃分析的方案已在PROSPERO：CRD42022326273注册。2022年5月10日注册。
