Evidence map›Paper›PMID 15592814›Full record

SynthesisIntensive care medicine2005

Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle.

Fiona Simpson, Gordon Stuart Doig

Abstract readMeta-AnalysisReview
PubMed Publisher
In one paragraph

Synthesis in Intensive care medicine, 2005. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 74 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
74citing papers in PubMed, 11 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

74 citing papers in PubMed, 11 syntheses or guidelines pooled it.

  1. Pooled it
  2. Guideline
  3. Pooled it
  4. Nutritional support for critically ill children.The Cochrane database of systematic reviews · 2016
    Pooled it
  5. Pooled it
  6. Nutrition intervention approaches to reduce malnutrition in oncology patients: a systematic review.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2016
    Pooled it
  7. Guideline
  8. Guideline
  9. Guideline
  10. Enteral versus parenteral nutrition after gastrointestinal surgery: a systematic review and meta-analysis of randomized controlled trials in the English literature.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2008
    Pooled it
  11. Guideline
  12. Trial
  13. Trial
  14. Impact of early parenteral nutrition on metabolism and kidney injury.Journal of the American Society of Nephrology : JASN · 2013
    Trial
  15. Trial
  16. Trial
  17. Review
  18. Physiological barriers to oral intake in survivors of critical illness: A scoping review.Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition · 2026
    Article
  19. Article
  20. Article

14 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

2 authors.

Fiona SimpsonDepartment of Nutrition, Royal North Shore Hospital, Pacific Highway, 2065 St. Leonards, Sydney, NSW, Australia.
Gordon Stuart Doig

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveControversy surrounds the use of parenteral nutrition in critical illness. Previous overviews used composite scales to identify high-quality trials, which may mask important differences in true methodological quality. Using a component-based approach this meta-analysis investigated the effect of trial quality on overall conclusions reached when standard enteral nutrition is compared to standard parenteral nutrition in critically ill patients.

methodsAn extensive literature search was undertaken to identify all eligible trials. We retrieved 465 publications, and 11 qualified for inclusion. Nine trials presented complete follow-up, allowing the conduct of an intention to treat analysis.

resultsAggregation revealed a mortality benefit in favour of parenteral nutrition, with no heterogeneity. A priori specified subgroup analysis demonstrated the presence of a potentially important treatment-subgroup interaction between studies of parenteral vs. early enteral nutrition compared to parenteral vs. late enteral. Six trials with complete follow-up reported infectious complications. Infectious complications were increased with parenteral use. The I(2) measure of heterogeneity was 37.7%.

conclusionsIntention to treat trials demonstrated reduced mortality associated with parenteral nutrition use. A priori subgroup analysis attributed this reduction to trials comparing parenteral to delayed enteral nutrition. Despite an association with increased infectious complications, a grade B+ evidence-based recommendation (level II trials, no heterogeneity) can be generated for parenteral nutrition use in patients in whom enteral nutrition cannot be initiated within 24 h of ICU admission or injury.

Indexed as

Critical CareEnteral NutritionParenteral NutritionCommunicable DiseasesHumansRandomized Controlled Trials as Topic

Identifiers

PMID15592814

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.