Evidence on the benefits of fiber-supplemented enteral nutrition (EN) in critically ill patients is inconsistent, and critical care nutrition guidelines lack recommendations based on high-quality evidence. This systematic review and meta-analysis (SRMA) aims to provide a current synthesis of the literature on this topic. For this SRMA of randomized controlled trials (RCT), electronic databases (MEDLINE, EMBASE, CENTRAL) were searched systematically from inception to January 2024 and updated in June 2024. Trials investigating clinical effects of fiber-supplemented EN versus placebo or usual care in adult critically ill patients were selected. Two independent reviewers extracted data and assessed the risk of bias of the included studies. Random-effect meta-analysis and trial sequential analysis (TSA) were conducted. The primary outcome was overall mortality, and one of the secondary outcomes was diarrhea incidence. Subgroup analyses were also performed for both outcomes. Twenty studies with 1405 critically ill patients were included. In conventional meta-analysis, fiber-supplemented EN was associated with a significant reduction of overall mortality (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 assessed to have very serious risk of bias, and, according to TSA, a type-1 error cannot be ruled out. No subgroup differences were found for the primary outcome. Very low-certainty evidence suggests that fiber-supplemented EN has clinical benefits. High-quality multicenter RCTs with large sample sizes are needed to substantiate any firm recommendation for its routine use in this group of patients. PROSPERO registration number: CRD42023492829.

中文翻译：

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补充纤维肠内营养对危重患者的疗效：随机对照试验的系统评价和荟萃分析与试验序贯分析


关于补充纤维的肠内营养 （EN） 对危重患者益处的证据不一致，危重症监护营养指南缺乏基于高质量证据的建议。本系统评价和荟萃分析 （SRMA） 旨在提供有关该主题的文献的当前综合。对于随机对照试验 （RCT） 的 SRMA，从建库到 2024 年 1 月系统检索了电子数据库 （MEDLINE、EMBASE、CENTRAL），并于 2024 年 6 月进行了更新。选择调查补充纤维 EN 与安慰剂或常规护理对成年危重患者临床影响的试验。两名独立评价员提取资料并评估纳入研究的偏倚风险。进行随机效应 meta 分析和试验序贯分析 （TSA）。主要结局是总死亡率，次要结局之一是腹泻发生率。还对两个结局进行了亚组分析。纳入了 20 项研究，涉及 1405 名危重患者。在常规荟萃分析中，补充纤维的 EN 与总死亡率（RR 0.66,95% CI 0.47,0.92，p = 0.01，I2 = 0%;12 项研究）和腹泻发生率（RR 0.70,95% CI 0.51,0.96，p = 0.03，I2 = 51%;11 项研究）的显著降低相关。然而，两种结局均被评估为具有非常严重的偏倚风险，并且根据 TSA，不能排除 1 型错误。未发现主要结局的亚组差异。极低质量证据表明，补充纤维的 EN 具有临床益处。需要大样本量的高质量多中心 RCT 来证实其在该组患者中常规使用的任何明确建议。PROSPERO 注册号：CRD42023492829。