Evidence map›Paper›PMID 19777207›Full record

SynthesisIntensive care medicine2009

Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta-analysis of randomised controlled trials.

Gordon S Doig, Philippa T Heighes, Fiona Simpson, Elizabeth A Sweetman, Andrew R Davies

Registry-linked trialAbstract readMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Intensive care medicine, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05710315 (Single-center, Proof of Concept, Prospective Study Evaluating the Utility of RELiZORB™ for the Treatment of Feeding Intolerance in Critically Ill Adults With Multi-Organ Failure), which is not on this map. Cited by 112 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
112citing papers in PubMed, 9 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.

NCT05710315 naactive not recruitingnot on this mapstarted 2025, after this paper: background citation

Single-center, Proof of Concept, Prospective Study Evaluating the Utility of RELiZORB™ for the Treatment of Feeding Intolerance in Critically Ill Adults With Multi-Organ Failure

TypeinterventionalSponsorInova Health Care ServicesRan2025 to 2026Enrolled32ConditionsMulti Organ Failure, Exocrine Pancreatic InsufficiencyArmsRELiZORB™, Placebo
3 · Its place in the literature

Who cites it

112 citing papers in PubMed, 9 syntheses or guidelines pooled it.

  1. Pooled it
  2. Guideline
  3. [S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2020
    Guideline
  4. Pooled it
  5. Guideline
  6. Guideline
  7. Brazilian recommendations of mechanical ventilation 2013. Part 2.Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia · 2014
    Guideline
  8. Pooled it
  9. Guideline
  10. Trial
  11. Early Enteral Nutrition Is Associated With Improved Clinical Outcomes in Critically Ill Children: A Secondary Analysis of Nutrition Support in the Heart and Lung Failure-Pediatric Insulin Titration Trial.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2020
    Trial
  12. Trial
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  14. Trial
  15. Trial
  16. Trial
  17. Markers of inflammation and coagulation may be modulated by enteral feeding strategy.JPEN. Journal of parenteral and enteral nutrition · 2012
    Trial
  18. Trial
  19. Trial
  20. Trial

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

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors.

Gordon S DoigNorthern Clinical School, University of Sydney, Sydney, 2006 NSW, Australia. gdoig@med.usyd.edu.au
Philippa T Heighes
Fiona Simpson
Elizabeth A Sweetman
Andrew R Davies

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo determine whether the provision of early standard enteral nutrition (EN) confers treatment benefits to critically ill patients.

methodsMedline and EMBASE were searched. Hand citation review of retrieved guidelines and systematic reviews were undertaken, and academic and industry experts were contacted. Methodologically sound randomised controlled trials (RCTs) conducted in critically ill patient populations that compared the delivery of standard EN, provided within 24 h of intensive care unit (ICU) admission or injury, to standard care were included. The primary analysis was conducted on clinically meaningful patient-oriented outcomes. Secondary analyses considered vomiting/regurgitation, pneumonia, bacteraemia, sepsis and multiple organ dysfunction syndrome. Meta-analyses were conducted using the odds ratio (OR) metric and a fixed effects model. The impact of heterogeneity was assessed using the I (2) metric.

resultsSix RCTs with 234 participants were analysed. The provision of early EN was associated with a significant reduction in mortality [OR = 0.34, 95% confidence interval (CI) 0.14-0.85] and pneumonia (OR = 0.31, 95% CI 0.12-0.78). There were no other significant differences in outcomes. A sensitivity analysis and a simulation exercise confirmed the presence of a mortality reduction.

conclusionAlthough the detection of a statistically significant reduction in mortality is promising, overall trial quality was low, trial size was small, and the findings may be restricted to the patient groups enrolled into included trials. The results of this meta-analysis should be confirmed by the conduct of a large multi-centre trial enrolling diverse critically ill patient groups.

Indexed as

Critical IllnessEnteral NutritionHumansIntensive Care UnitsMortalityPatient AdmissionRandomized Controlled Trials as TopicTime FactorsWounds and Injuries

Identifiers

PMID19777207

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

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.