Total parenteral nutrition combined with enteral nutrition in treatment of severe acute pancreatitis

Zhang, Yongsheng; Xiao-liang, Shu; Zhong, Jing-xia; Sheng, Ying; Meng, Bin

doi:10.3724/sp.j.1008.2011.00737

Cited by 2 publications

(8 citation statements)

References 8 publications

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“…The 25 eligible references after the full-text review were from 22 RCTs, and they were included in this study for qualitative and quantitative synthesis. [6–13, 40–56] Fig 1 presents a flow diagram of study selection according to PRISMA guidelines.…”

Section: Resultsmentioning

confidence: 99%

“…The 22 RCTs included in the study consisted of 1379 patients and were conducted in the United States,[40, 45, 51] Canada,[11] China,[13, 41, 54–56] Croatia,[53] Greece,[10] Hungary,[47] India,[7, 43, 52] New Zealand,[44, 46, 48, 49] Russia,[12] Scotland,[42, 50] Spain,[6] Sweden,[8] and the United Kingdom[9] from 1984 to 2012. These RCTs included 4 therapies: NNS (n = 190), TPN (n = 420), NG (n = 163), and NJ (n = 562).…”

Section: Resultsmentioning

confidence: 99%

“…Eleven RCTs provided all patients with prophylactic antibiotics,[7, 9, 10, 12, 13, 41, 50, 53–56] and 17 RCTs only included patients with SAP (Table 1). [6–13, 41–43, 50, 52–56] Among the 22 trials, two authors had agreements on 264 main extractions (196 information were extracted and 68 items were no information), and there were 22 disagreements in the individual review. The kappa coefficient (0.808) indicated that the agreement between authors was acceptable.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 22 RCTs, 16 showed data on the total number of infectious patients. [6–12, 41, 45, 47, 51–56] In overall, per infected patient proximately had one to two kind of infections. In the consistency model, the results showed that NJ led to a significantly lower total infection rate compared with TPN (RR, 0.59; 95% CI, 0.38, 0.90), but NG had the largest effect size compared with other therapies (Fig 2 and Appendix A1 in S1 File).…”

Section: Resultsmentioning

confidence: 99%

“…The 12 RCTs that recruited patients with pSAP showed that the result in the consistency model was similar to the overall pooling. [6–12, 41, 52, 54–56] The NJ led to a significantly lower total infection rate compared with TPN (RR, 0.56; 95% CI, 0.34, 0.92), but NG had the largest effect size compared with other therapies (Table 2 and Appendix B1 in S1 File). Moreover, the SUCRA value showed that NG may be the optimal nutritional route (mean rank = 1.6; SUCRA = 80.9), and TPN should be avoided when treating patients with acute pancreatitis (mean rank = 3.2; SUCRA = 26.6) (Appendix B2 in S1 File).…”

Section: Resultsmentioning

confidence: 99%

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Infection rate among nutritional therapies for acute pancreatitis: A systematic review with network meta-analysis of randomized controlled trials

Hsieh

Lin

et al. 2019

PLoS ONE

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Background Infection in acute pancreatitis (AP) is associated with nutritional therapies including naso-gastric (NG), naso-jejunal (NJ), and total parenteral nutrition (TPN). To examine infections among NG, NJ, TPN, and no nutritional support (NNS) in treating patients with AP. Methods The investigators completed comprehensive search in the Cochrane library, EMBASE, PubMed, Web of Science, and ClinicalTrials.gov without restriction on language and publication date before January 21, 2019. They also searched the reference lists of relevant studies for randomized controlled trials (RCTs) comparing NG, NJ, TPN, and NNS among patients with AP. Quantitative synthesis was conducted in a contrast-based network meta-analysis. To clarify effects, a network meta-analysis was conducted to calculate the surface under the cumulative ranking curve (SUCRA). Beside of overall infections, the event rates of infected pancreatic necrosis, bacteremia, line infection, pneumonia, urinary tract infection, and other types of infections were measured. Results The network meta-analysis of 16 RCTs showed that NJ had significantly lower overall infection rates compared with TPN (risk ratio: 0.59; 95% confidence interval: 0.38, 0.90); and NG had a larger effect size and higher rank probability compared with NJ, TPN, and NNS (mean rank = 1.7; SUCRA = 75.8). TPN was the least preferred (mean rank = 3.2; SUCRA = 26.6). Conclusions NG and NJ may be preferred therapies for treating patients with AP. Clinicians may consider NG as a first-line treatment for patients with AP (including severe AP) and even in patients receiving prophylactic antibiotics. In addition, we found that NNS should be avoided when treating patients with severe AP.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Infection rate among nutritional therapies for acute pancreatitis: A systematic review with network meta-analysis of randomized controlled trials

Hsieh

Lin

et al. 2019

PLoS ONE

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Nutrition support in hospitalised adults at nutritional risk

Feinberg

Nielsen

Korang

et al. 2017

Cochrane Database of Systematic Reviews

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There is low-quality evidence for the effects of nutrition support on mortality and serious adverse events. Based on the results of our review, it does not appear to lead to a risk ratio reduction of approximately 10% or more in either all-cause mortality or serious adverse events at short-term and long-term follow-up.There is very low-quality evidence for an increase in weight with nutrition support at the end of treatment in hospitalised adults determined to be at nutritional risk. The effects of nutrition support on all remaining outcomes are unclear.Despite the clinically heterogenous population and the high risk of bias of all included trials, our analyses showed limited signs of statistical heterogeneity. Further trials may be warranted, assessing enteral nutrition (tube-feeding) for different patient groups. Future trials ought to be conducted with low risks of systematic errors and low risks of random errors, and they also ought to assess health-related quality of life.

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Total parenteral nutrition combined with enteral nutrition in treatment of severe acute pancreatitis

Cited by 2 publications

References 8 publications

Infection rate among nutritional therapies for acute pancreatitis: A systematic review with network meta-analysis of randomized controlled trials

Infection rate among nutritional therapies for acute pancreatitis: A systematic review with network meta-analysis of randomized controlled trials

Nutrition support in hospitalised adults at nutritional risk

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