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October 20, 1999

Total Parenteral Nutrition for Critically Ill Patients

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;282(15):1423-1425. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-15-jac90009

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.