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High-carbohydrate, high-protein, low-fat versus low-carbohydrate, high-protein, high-fat enteral feeds for burns

  1. Bronwen Masters1,*,
  2. Shahram Aarabi2,
  3. Feroze Sidhwa3,
  4. Fiona Wood4

Editorial Group: Cochrane Injuries Group

Published Online: 18 JAN 2012

Assessed as up-to-date: 28 NOV 2011

DOI: 10.1002/14651858.CD006122.pub3


How to Cite

Masters B, Aarabi S, Sidhwa F, Wood F. High-carbohydrate, high-protein, low-fat versus low-carbohydrate, high-protein, high-fat enteral feeds for burns. Cochrane Database of Systematic Reviews 2012, Issue 1. Art. No.: CD006122. DOI: 10.1002/14651858.CD006122.pub3.

Author Information

  1. 1

    Sports Institute Northern Ireland, Newtownabbey, Northern Ireland, UK

  2. 2

    University of Washington, Department of Surgery, Seattle, Washington, USA

  3. 3

    Boston University Medical Center, Boston, Massachusetts, USA

  4. 4

    Royal Perth Hospital, Plastic Surgery, Perth, Western Australia, Australia

*Bronwen Masters, Sports Institute Northern Ireland, University of Ulster, Newtownabbey, Northern Ireland, BT37 0QB, UK. bronwen.masters@bigpond.com. bronwen.masters@aspetar.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 JAN 2012

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Characteristics of included studies [ordered by study ID]
Garrel 1995

MethodsProspective randomized controlled trial, single centre


ParticipantsPatients at least 16 years of age with at least 20% total body surface area burned, excluding first-degree burns


InterventionsLow-carbohydrate, high-fat control group; high-carbohydrate, low-fat group 1; high-carbohydrate, low-fat group 2


OutcomesMortality, sepsis score, pneumonia, diarrhoea (cumulative incidence as a percentage, total days with, and mean days with), constipation (number of patients experiencing, and total days with), glycaemic control (mean days requiring exogenous insulin, and mean insulin days), number of patients with bacteraemia, number of patients with wound infection, number of patients with pneumonia, mean days on ventilator, discharge weight as a percentage of pre-burn weight


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskRandom number table (p482)

Allocation concealment (selection bias)Low riskInvestigator not aware of which group patients would be assigned (p482)

Blinding (performance bias and detection bias)
Patient and the outcome assessor
High riskNurses and surgeon blinded (p483); investigator aware of allocation after randomization (p482)

Incomplete outcome data (attrition bias)
All outcomes Less than 6 weeks
High riskPatients who died > 3 weeks into the study were excluded, Garrel reports "available case" data (p484)

Incomplete outcome data (attrition bias)
All outcomes More than 6 weeks
Low riskN/A. Study lasted 30 days (p483)

Selective reporting (reporting bias)Unclear riskStudy protocol not available/not identified

Other biasUnclear riskUnknown

Gottschlich 1990a

MethodsProspective randomized controlled trial, two centres


ParticipantsPatients requiring enteral feeds. No age or size of burn restriction, all patients had ≥ 10% TBSA burns


InterventionsGroup 1 low-carbohydrate, high-fat; group 2 high-carbohydrate, low-fat; group 3 low-carbohydrate, high-fat


OutcomesMortality, pneumonia, days on ventilator, sepsis, diarrhoea (cumulative incidence as a percentage, total days with, and mean days with), constipation (number of patients experiencing, and total days with), glycaemic control (mean days requiring exogenous insulin, and mean insulin days), number of patients with bacteraemia, number of patients with wound infection, number of patients with pneumonia, mean days on ventilator, discharge weight as a percentage of pre-burn weight, length of stay per percentage burn and mortality.


NotesEmail correspondence with author


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"random number table" p226 and confirmed through Gottschlich correspondence.

Allocation concealment (selection bias)Unclear riskNot stated

Blinding (performance bias and detection bias)
Patient and the outcome assessor
Low risk"double-blind study" p.225 "The tube feeding was delivered in cartons and was designated research tube feeding on the label.  The caregivers and patients had no idea which tube feeding intervention they were receiving" Gottschlich correspondence

Incomplete outcome data (attrition bias)
All outcomes Less than 6 weeks
Low riskAuthors' judgement: inpatient study, all outcomes routine clinical practise, no reported loss to follow up

Incomplete outcome data (attrition bias)
All outcomes More than 6 weeks
Low riskAuthors' judgement: short study duration, "tube feeding support ranged from 1 week to 61 days" p229, inpatient study (p 227), all outcomes routine clinical outcomes, no reported loss to follow up

Selective reporting (reporting bias)Unclear riskNo protocol published in advance Gottschlich correspondence

Other biasUnclear riskUnknown

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Hart 2001Does not compare high-carbohydrate, high-protein, low-fat regimen to low-carbohydrate, high-protein, high-fat regimen

Saffle 1997Does not compare high-carbohydrate, high-protein, low-fat regimen to low-carbohydrate, high-protein, high-fat regimen

Serog 1983Does not compare high-carbohydrate, high-protein, low-fat regimen to low-carbohydrate, high-protein, high-fat regimen

 
Comparison 1. High-carbohydrate vs high-fat enteral feeding

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Mortality at final follow-up290Odds Ratio (M-H, Random, 95% CI)0.36 [0.11, 1.15]

 2 Risk of pneumonia287Odds Ratio (M-H, Random, 95% CI)0.12 [0.04, 0.39]

 3 Days on ventilator1Mean Difference (IV, Random, 95% CI)Subtotals only