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To the Editor: The meta-analysis of total parenteral nutrition (TPN) in the critically ill patient by Dr Heyland and colleagues¹ illustrates several of the serious problems of meta-analysis compared with randomized clinical trials. These involve heterogeneity of the trials included, failure of the investigators performing the meta-analysis to understand the basic issues, and defects in abstracting.² Several problems illustrate why there should be a reluctance to base clinical decisions about the use of TPN on the distilled findings from this meta-analysis.

First, the authors state that randomized trials have demonstrated that enteral nutrition results in a decrease in gastrointestinal permeability and lower infection rates. An extensive review³ found no convincing evidence for the benefit of parenteral over enteral nutrition with regard to intestinal morphology or permeability or bacterial translocation in humans. The 3 studies cited to support a reduced infection rate with enteral nutrition over TPN in trauma patients all . . . [Full Text of this Article]

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RELATED ARTICLE

Total Parenteral Nutrition in the Critically Ill Patient: A Meta-analysis
Daren K. Heyland, Shaun MacDonald, Laurie Keefe, and John W. Drover
JAMA. 1998;280(23):2013-2019.
ABSTRACT | FULL TEXT