Compare permissive underfeeding enteral nutrition with stand feeding under enough protein intakes on mortality in critically ill patients: a systematic review and meta-analysis planning councils in the United States

Background: Though many guidelines about nutritional support, there are still dispute about permissive underfeeding, especially when the protein supply was enough. We performed a systematic review and meta-analysis to compare underfeeding with standard feeding on the clinical outcome of ICU patients. Methods: Data from the MEDLINE, EMBASE, Cochrane database, Web of Science and https://clinicaltrials.gov/ (until December, 31, 2016) were searched to identify relevant studies. Trial sequential analysis (TSA) was also calculated. Results: A total of 6 studies with 1455 patients were included in the analysis. Overall, there was no significant difference in the risk of mortality [RR=0.82, 95% CI (0.59, 1.14)] and the length of ICU stay [Mean Difference=-0.94, 95% CI (-5.57, 3.69)] in the permissive underfeeding group with standard feeding group. The incidence of nosocomial acquired infections also had not significant difference in the two group [RR 0.95; 95% CI (0.83, 1.09); p=0.46]. Conclusion: This meta-analysis demonstrated there is no difference in the risk of hospital mortality, ICU length of stay (LOS) and nosocomial acquired infection between permissive underfeeding enteral nutrition and standard feeding under enough protein.