SynthesisCritical care (London, England)2013
Comparisons between intragastric and small intestinal delivery of enteral nutrition in the critically ill: a systematic review and meta-analysis.
Synthesis in Critical care (London, England), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 24 papers, 6 of them syntheses that pooled 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.
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.
Who cites it
24 citing papers in PubMed, 6 syntheses or guidelines pooled it, 67 citations in OpenAlex.
- Strategies to Maximize the Benefits of Evidence-Based Enteral Nutrition: A Narrative Review.Nutrients · 2025Pooled it
- Is metoclopramide beneficial for the postpyloric placement of nasoenteric tubes? A systematic review and meta-analysis of randomized controlled trials.Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition · 2022Pooled it
- Gastric-tube versus post-pyloric feeding in critical patients: a systematic review and meta-analysis of pulmonary aspiration- and nutrition-related outcomes.European journal of clinical nutrition · 2021Pooled it
- Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.Intensive care medicine · 2017Guideline
- Lower versus higher dose of enteral caloric intake in adult critically ill patients: a systematic review and meta-analysis.Critical care (London, England) · 2016Pooled it
- Post-pyloric versus gastric tube feeding for preventing pneumonia and improving nutritional outcomes in critically ill adults.The Cochrane database of systematic reviews · 2015Pooled it
- Metoclopramide or domperidone improves post-pyloric placement of spiral nasojejunal tubes in critically ill patients: a prospective, multicenter, open-label, randomized, controlled clinical trial.Critical care (London, England) · 2015Trial
- Success Rates for Endoscopic Placement of Post-Pyloric Nasoenteric Tube Underperform Expectations.Current gastroenterology reports · 2025Review
- The Japanese Critical Care Nutrition Guideline 2024.Journal of intensive care · 2025Review
- Nine Myths about Enteral Feeding in Critically Ill Adults: An Expert Perspective.Advances in nutrition (Bethesda, Md.) · 2025Review
- A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice.Critical care (London, England) · 2021Review
- An overview of percutaneous endoscopic gastrostomy tube placement in the intensive care unit.Journal of thoracic disease · 2021Review
- Gastrointestinal Manifestations of COVID-19: Impact on Nutrition Practices.Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition · 2020Review
- Nutrition in critically ill patients with COVID-19: Challenges and special considerations.Clinical nutrition (Edinburgh, Scotland) · 2020Article
- Gastrointestinal dysfunction in the critically ill: a systematic scoping review and research agenda proposed by the Section of Metabolism, Endocrinology and Nutrition of the European Society of Intensive Care Medicine.Critical care (London, England) · 2020Article
- Article
- The intensive care medicine research agenda in nutrition and metabolism.Intensive care medicine · 2017Review
- The role of nutritional support in the physical and functional recovery of critically ill patients: a narrative review.Critical care (London, England) · 2017Review
- Year in review 2013: Critical Care--metabolism.Critical care (London, England) · 2014Review
- Effect of intragastric versus small intestinal delivery of enteral nutrition on the incidence of pneumonia in critically ill patients: a complementary meta-analysis.Critical care (London, England) · 2014Article
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
12 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe largest cohort of critically ill patients evaluating intragastric and small intestinal delivery of nutrients was recently reported. This systematic review included recent data to compare the effects of small bowel and intragastric delivery of enteral nutrients in adult critically ill patients.
methodsThis is a systematic review of all randomised controlled studies published between 1990 and March 2013 that reported the effects of the route of enteral feeding in the critically ill on clinically important outcomes.
resultsData from 15 level-2 studies were included. Small bowel feeding was associated with a reduced risk of pneumonia (Relative Risk, RR, small intestinal vs. intragastric: 0.75 (95% confidence interval 0.60 to 0.93); P=0.01; I2=11%). The point estimate was similar when only studies using microbiological data were included. Duration of ventilation (weighted mean difference: -0.36 days (-2.02 to 1.30); P=0.65; I2=42%), length of ICU stay (WMD: 0.49 days, (-1.36 to 2.33); P=0.60; I2=81%) and mortality (RR 1.01 (0.83 to 1.24); P=0.92; I2=0%) were unaffected by the route of feeding. While data were limited, and there was substantial statistical heterogeneity, there was significantly improved nutrient intake via the small intestinal route (% goal rate received: 11% (5 to 16%); P=0.0004; I2=88%).
conclusionsUse of small intestinal feeding may improve nutritional intake and reduce the incidence of ICU-acquired pneumonia. In unselected critically ill patients other clinically important outcomes were unaffected by the site of the feeding tube.
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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.