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The following is a summary of “Efficacy of fiber-supplemented enteral nutrition in critically ill patients: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis,” published in the November 2024 issue of Critical Care by Koch et al.
Researchers conducted a retrospective study to examine the efficacy of fiber-supplemented enteral nutrition (EN) in patients with critical illness.
They searched electronic databases (MEDLINE, EMBASE, CENTRAL) from inception to January 2024, updating the search in June 2024, for randomized controlled trials (RCTs) investigating the clinical effects of fiber-supplemented EN vs placebo or usual care in adult patients with critical illness, 2 independent reviewers extracted data and investigated the risk of bias in the included studies. A random-effects meta-analysis and trial sequential analysis (TSA) was also performed with primary outcome as the overall mortality, and 1 of the secondary outcomes was diarrhea incidence with subgroup analyses for both outcomes.
The results showed that 20 studies with 1,405 individuals with critical illness were included. In the conventional meta-analysis, fiber-supplemented EN was linked to a drop in overall mortality (relative risk [RR] 0.66, 95% CI 0.47, 0.92, P = 0.01, I2= 0%; 12 studies) and diarrhea incidence (RR 0.70, 95% CI 0.51, 0.96, P = 0.03, I2 = 51%; 11 studies). However, both outcomes were found to have a severe risk of bias, and TSA suggested that a type-1 error could not be excluded, and no subgroup differences were identified for the primary outcome.
Investigators concluded that very low-certainty evidence indicated potential clinical benefits of fiber-supplemented EN, and high-quality multicenter RCTs with large sample sizes were needed to support any firm recommendations for its routine use in individuals with critical illness.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05128-2
