NUTRITIONAL SUPPORT IN THE CRITICALLY ILL PATIENT: A Critical Review of the Evidence
Section snippets
Search Strategy
Table 1A computerized bibliographic search of MEDLINE (including pre-MEDLINE) from 1980 to December, 1996, to locate all relevant articles was conducted. The terms randomized controlled trial, double blind method, clinical trial, placebo, and comparative study were combined with explode parenteral nutrition, total, enteral nutrition, intensive care units, and critical care. Citations were limited to English-language studies on adult patients. Reference lists of relevant review articles and
Study Identification and Selection
A total of 475 citations were identified through searching the computerized bibliographic databases. Of these potentially eligible papers, 58 met the inclusion criteria (see below). Included articles were grouped into categories addressing the following questions:
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Does providing nutritional support, compared to no nutritional support, make a difference in patient outcomes?
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What is the effect of EN compared to TPN with respect to infectious outcomes?
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How does timing of administration of EN
CONCLUSION
The pioneering work of many investigators has led us to understand the important role that nutrition plays in critical illness. Although providing nutritional support to critically ill patients can alter nutritional outcomes, there are few randomized controlled trials conclusively demonstrating that any form of nutritional support improves the morbidity and mortality of critically ill patients. The absence of data does not mean that nutritional support is ineffective. In many cases, it means
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Address reprint requests to D.K. Heyland, MD, Angada 3, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario, Canada K7L 2V7
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Department of Medicine, and the Department of Community Health and Epidemiology, Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada