Evidence map›Paper›PMID 35172856›Full record

Trial reportCritical care (London, England)2022

Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial.

Lu Ke, Jiajia Lin, Gordon S Doig, Arthur R H van Zanten, Yang Wang, Juan Xing, Zhongheng Zhang, Tao Chen, Lixin Zhou, Dongpo Jiang and 89 more

Erratum issuedOpen access · goldAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Critical care (London, England), 2022. 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 31 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
31citing papers in PubMed, 1 pooled it
4.5field-weighted citation impact, top 4% of its field
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

31 citing papers in PubMed, 1 synthesis or guideline pooled it, 46 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Trial
  4. Article
  5. Article
  6. Article
  7. Article
  8. Article
  9. Metabolic acidosis and sodium bicarbonate therapy in critically ill patients: A multinational survey of international and Chinese practitioners.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2026
    Article
  10. Article
  11. Article
  12. Article
  13. Review
  14. Article
  15. Article
  16. Early enteral nutrition in critically-ill patients.World journal of critical care medicine · 2025
    Review
  17. Article
  18. Article
  19. Review
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

99 authors at 20 institutions in 4 countries.

Lu Ke *Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000, Jiangsu Province, China.
Jiajia Lin *Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000, Jiangsu Province, China.
Gordon S DoigNorthern Clinical School, Royal North Shore Hospital, University of Sydney, Sydney, Australia.
Arthur R H van ZantenDepartment of Intensive Care Medicine, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands.
Yang WangDepartment of Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Juan XingBenq Medical Center, Nanjing, China.
Zhongheng ZhangDepartment of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Tao ChenTropical Clinical Trials Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK.
Lixin ZhouFirst People's Hospital of Foshan, Foshan, China.
Dongpo JiangDaping Hospital, Army Medical University, Chongqing, China.
Qindong ShiFirst Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China.
Jiandong LinFirst Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Jun LiuSuzhou Municipal Hospital, Suzhou, China.
Aibin ChengNorth China University of Science and Technology Affiliated Hospital, Tangshan, China.
Yafeng LiangQindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China.
Peiyang GaoChengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, China.
Junli SunLuoyang Central Hospital Affiliated To Zhengzhou University, Luoyang, China.
Wenming LiuChangzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, Changzhou, China.
Zhenyu YangThe Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Rumin ZhangZibo Central Hospital, Zibo, China.
Wei XingDepartment of Intensive Care Medicine, The Third Xiangya Hospital of Central South University, Changsha, China.
An ZhangThe Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Zhigang ZhouFirst People's Hospital of Kunming, Kunming, China.
Tingfa ZhouLinyi City People Hospital, Shandong, China.
Yang LiuTangshan Gongren Hospital, Tangshan, China.
Fei TongHebei Medical University Second Affiliated Hospital, Shijiazhuang, China.
Qiuhui WangWuxi People's Hospital, Wuxi, China.
Aijun PanAnhui Provincial Hospital, Hefei, China.
Xiaobo HuangDepartment of Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
Chuming FanFirst People's Hospital of Yunnan, Kunming, China.
Weihua LuYijishan Hospital of Wannan Medical College, Wuhu, China.
Dongwu ShiShanxi Provincial People's Hospital, Taiyuan, China.
Lei WangShanxi Medical University First Affiliated Hospital, Taiyuan, China.
Wei LiThe People's Hospital of Fujian Province, Fuzhou, China.
Liming GuPeople's Hospital of Yuxi City, Yuxi, China.
Yingguang XieJining First People's Hospital, Jining, China.
Rongqing SunThe First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Feng GuoDepartment of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Lin HanPeople's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
Lihua ZhouAffiliated Hospital of Inner Mongolia Medical College, Huhehaote, China.
Xiangde ZhengDazhou Central Hospital, Dazhou, China.
Feng ShanQindao University Medical College Affiliated Hospital, Qindao, China.
Jianbo LiuInner Mongolia People's Hospital, Huhehaote, China.
Yuhang AiXiangya Hospital Central South University, Changsha, China.
Yan QuQingdao Municipal Hospital Group, Qingdao, China.
Liandi LiQindao University Medical College Affiliated Hospital, Qindao, China.
Hailing LiNo.971 Hospital of People's Liberation Army Navy, Qingdao, China.
Zhiguo PanGeneral Hospital of Southern Theatre Command, Guangzhou, China.
Donglin XuGuangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.
Zhiqiang ZouUnion Hospital of Fujian Medical University, Fuzhou, China.
Yan GaoThe General Hospital of Shenyang Military, Shenyan, China.
Chunli YangJiangxi Provincial People's Hospital, Nanchang, China.
Qiuye KouThe Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Xijing ZhangDepartment of Anaesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
Jinglan WuShenzhen Nanshan People's Hospital, Shenzhen, China.
Chuanyun QianKuming Medical University First Affiliated Hospital, Kuming, China.
Weixing ZhangPeking University Shenzhen Hospital, Guandong, China.
Minjie ZhangGeneral ICU, Jinan University First Affiliated Hospital, Jinan, China.
Yuan ZongShaanxi Provincial People's Hospital, Xi'an, China.
Bingyu QinHenan Provincial People's Hospital, Zhengzhou, China.
Fusen ZhangTai'an City Central Hospital, Tai'an, China.
Zhe ZhaiThe Fourth Hospital of Harbin Medical University, Harbin, China.
Yun SunAnhui Medical University Second Affiliated Hospital, Hefei, China.
Ping ChangSouthern Medical University Zhujiang Hospital, Guangzhou, China.
Bo YuDepartment of Critical Care Medicine, the Second Xiangya Hospital of Central South University, Changsha, 410000, Hunan, China.
Min YuFirst People's Hospital of Yichang, Yichang, China.
Shiying YuanUnion Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
Yijun DengYancheng First People's Hospital, Yancheng, China.
Liyun ZhaoGuangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China.
Bin ZangChina Medical University Affiliated Shengjing Hospital, Shenyang, China.
Yuanfei LiChangsha Central Hospital Affiliated to University of South China, Changsha, China.
Fachun ZhouChongqing Medical University First Affiliated Hospital, Chongqing, China.
Xiaomei ChenDepartment of Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
Min ShaoThe First Affiliated Hospital of Anhui Medical University, Hefei, China.
Weidong WuShanxi Bethune Hospital, Taiyuan, China.
Ming WuHealth Science Center, The Second People's Hospital of Shenzhen, First Affiliated Hospital of Shenzhen University, Shenzhen, China.
Zhaohui ZhangYichang Central People's Hospital, Yichang, China.
Yimin LiFirst Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Qiang GuoFirst Affiliated Hospital of Soochow University, Suzhou, China.
Zhiyong WangHebei Medical University, Third Affiliated Hospital, Shijiazhuang, China.
Yuanqi GongThe Second Affiliated Hospital of Nanchang University, Jiangxi, China.
Yunlin SongThe First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China.
Kejian QianThe First Affiliated Hospital of Nanchang University, Jiangxi, China.
Yongjian FengNeurosurgical ICU, Jinan University First Affiliated Hospital, Jinan, China.
Baocai FuYantai Mountain Hospital, Yantai, China.
Xueyan LiuShenzhen People's Hospital, Shenzhen, China.
Zhiping LiHunan Provincial People's Hospital, Changsha, China.
Chuanyong GongTianjing Hospital of Integration of Chinese and Western Medicine, Tianjing, China.
Cheng SunGuangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Jian YuThe Second Hospital of Dalian Medical University, Liaoning, China.
Zhongzhi TangWuhan General Hospital of Guangzhou Military Region, Wuhan, China.
Linxi HuangShantou University Medical College First Affiliated Hospital, Shantou, China.
Biao MaJining Medical College Affiliated Hospital, Jining, China.
Zhijie HeSun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
Qingshan ZhouHubei Provincial People's Hospital, Wuhan, China.
Rongguo YuFujian Provincial Hospital, Fujian, China.
Zhihui TongDepartment of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000, Jiangsu Province, China. njzyantol@hotmail.com.
Weiqin LiDepartment of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000, Jiangsu Province, China. ctgchina@medbit.cn.ORCID http://orcid.org/0000-0002-8483-6264
Chinese Critcal Care Nutrition Trials Group (CCCNTG)
Central South University · CNFujian Medical University · CNHebei Medical University · CNAnhui Medical University · CNSun Yat-sen University · CNDalian Medical University · CNHarbin Medical University · CNKunming Medical University · CNNanchang University · CNSir Run Run Shaw Hospital · CNNanjing General Hospital of Nanjing Military Command · CNShanxi Medical University · CNQingdao University · CNTianjin Hospital · CNWannan Medical College · CNArmy Medical University · CNFirst People's Hospital of Foshan · CNFujian Provincial Hospital · CNGuangdong Provincial Hospital of Traditional Chinese Medicine · CNJiangxi Provincial People's Hospital · CN

Funding

Jiangsu Provincial Key Research and Development Program BE2015685
6 · The paper itself

Abstract

backgroundPrevious cluster-randomized controlled trials evaluating the impact of implementing evidence-based guidelines for nutrition therapy in critical illness do not consistently demonstrate patient benefits. A large-scale, sufficiently powered study is therefore warranted to ascertain the effects of guideline implementation on patient-centered outcomes.

methodsWe conducted a multicenter, cluster-randomized, parallel-controlled trial in intensive care units (ICUs) across China. We developed an evidence-based feeding guideline. ICUs randomly allocated to the guideline group formed a local "intervention team", which actively implemented the guideline using standardized educational materials, a graphical feeding protocol, and live online education outreach meetings conducted by members of the study management committee. ICUs assigned to the control group remained unaware of the guideline content. All ICUs enrolled patients who were expected to stay in the ICU longer than seven days. The primary outcome was all-cause mortality within 28 days of enrollment.

resultsForty-eight ICUs were randomized to the guideline group and 49 to the control group. From March 2018 to July 2019, the guideline ICUs enrolled 1399 patients, and the control ICUs enrolled 1373 patients. Implementation of the guideline resulted in significantly earlier EN initiation (1.20 vs. 1.55 mean days to initiation of EN; difference - 0.40 [95% CI - 0.71 to - 0.09]; P = 0.01) and delayed PN initiation (1.29 vs. 0.80 mean days to start of PN; difference 1.06 [95% CI 0.44 to 1.67]; P = 0.001). There was no significant difference in 28-day mortality (14.2% vs. 15.2%; difference - 1.6% [95% CI - 4.3% to 1.2%]; P = 0.42) between groups.

conclusionsIn this large-scale, multicenter trial, active implementation of an evidence-based feeding guideline reduced the time to commencement of EN and overall PN use but did not translate to a reduction in mortality from critical illness.

trial registrationISRCTN, ISRCTN12233792 . Registered November 20th, 2017.

Indexed as

Critical IllnessNutritional SupportChinaHumansIntensive Care UnitsTime FactorsCluster-randomized trialEvidence-based guidelineIntensive care unitNutrition therapy

Identifiers

PMID35172856
PMCPMC8848648
OpenAlexW4212928251

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Registered trials

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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.