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
Abstract
Purpose To determine whether the provision of early standard enteral nutrition (EN) confers treatment benefits to critically ill patients. Methods Medline 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. Results Six 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. Conclusion Although 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.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Enteral nutrition can decrease mortality.
“and can decrease mortality,134,136,137”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [136]
Cites
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763 · see citing works
Assessing the quality of controlled clinical trials
Jüni, P., Altman, D. G., & Egger, M. (2001) · BMJ · doi:10.1136/bmj.323.7303.42 · Cited by 3,309 · cited 1× · see citing works
“All included trials were appraised on the reporting of three key methodological criteria: (1) the maintenance of allocation concealment, (2) the use of any form of blinding and (3) the completeness of patient follow-up [15].”
BackgroundEgger, M., Jüni, P., Bartlett, C., Holenstein, F., & Sterne, J. (2003) · Health Technology Assessment · doi:10.3310/hta7010 · Cited by 1,181 · cited 1× · see citing works
“All controlled trials comparing primary feeding interventions published in any language were identified [10, 11].”
BackgroundDirection and impact of language bias in meta-analyses of controlled trials: empirical study
Jüni, P., Holenstein, F., Sterne, J., Bartlett, C., & Egger, M. (2002) · International Journal of Epidemiology · doi:10.1093/ije/31.1.115 · Cited by 892 · see citing works
Early versus late enteral feeding of mechanically ventilated patients: Results of a clinical trial.
Ibrahim, E., Mehringer, L., Prentice, D., Sherman, G., Schaiff, R., Fraser, V, & Kollef, M. (2002) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607102026003174 · Cited by 341 · see citing works
Pupelis, G., Selga, G., Austrums, E., & Kaminski, A. (2001) · Nutrition · doi:10.1016/s0899-9007(00)00508-6 · Cited by 129 · see citing works
Villar, J., Mackey, M. E., Carroli, G., & Donner, A. (2001) · Statistics in Medicine · doi:10.1002/sim.1096 · Cited by 96 · see citing works
Early Enteral Nutrition Does Not Decrease Hypermetabolism Associated with Burn Injury
Peck, M. D., Kessler, M., Cairns, B. A., Chang, Y.-H., Ivanova, A., & Schooler, W. (2004) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/01.ta.0000145826.84657.38 · Cited by 91 · see citing works
Nguyen, N. Q., Fraser, R. J., Bryant, L. K., Burgstad, C., Chapman, M. J., Bellon, M., Wishart, J., Holloway, R. H., & Horowitz, M. (2008) · Critical Care Medicine · doi:10.1097/ccm.0b013e31816fc457 · Cited by 90 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock
Dellinger, R. P., Levy, M. M., Rhodes, A., Annane, D., Gerlach, H., Opal, S. M., Sevransky, J. E., Sprung, C. L., Douglas, I. S., Jaeschke, R., et al. (2013) · Critical Care Medicine · doi:10.1097/ccm.0b013e31827e83af · Cited by 9,694 · see citing works
Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016.
Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J. E., Sprung, C. L., Nunnally, M. E., et al. (2017) · Intensive Care Medicine · doi:10.1007/s00134-017-4683-6 · Cited by 6,621 · see citing works
McClave, S. A., Taylor, B. E., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., et al. (2016) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607115621863 · Cited by 3,982 · see citing works
Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016.
Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J. E., Sprung, C. L., Nunnally, M. E., et al. (2017) · Critical Care Medicine · doi:10.1097/ccm.0000000000002255 · Cited by 3,652 · see citing works
Taylor, B. E., McClave, S. A., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., et al. (2016) · Critical Care Medicine · doi:10.1097/ccm.0000000000001525 · Cited by 1,476 · see citing works
The National Heart, L., Rice, T. W., Wheeler, A. P., Thompson, B. T., Steingrub, J., Hite, R. D., Moss, M., Morris, A., Dong, N., & Rock, P. (2012) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.2012.137 · Cited by 935 · see citing works
Reignier, J., Boisramé-Helms, J., Brisard, L., Lascarrou, J.-B., Ait Hssain, A., Anguel, N., Argaud, L., Asehnoune, K., Asfar, P., Bellec, F., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(17)32146-3 · Cited by 595 · see citing works
Metabolic and nutritional support of critically ill patients: consensus and controversies
Preiser, J.-C., van Zanten, A. R., Berger, M. M., Biolo, G., Casaer, M. P., Doig, G. S., Griffiths, R. D., Heyland, D. K., Hiesmayr, M., Iapichino, G., et al. (2015) · Critical Care · doi:10.1186/s13054-015-0737-8 · Cited by 416 · see citing works
Self-citationAndrews, P. J. D., Avenell, A., Noble, D. W., Campbell, M. K., Croal, B. L., Simpson, W. G., Vale, L. D., Battison, C. G., Jenkinson, D. J., Cook, J. A., et al. (2011) · BMJ · doi:10.1136/bmj.d1542 · Cited by 379 · see citing works
Nutrition in the acute phase of critical illness
Casaer, M. P., & Van den Berghe, G. (2014) · New England Journal of Medicine · doi:10.1056/nejmra1304623 · Cited by 335 · see citing works
Davies, A. R., Morrison, S. S., Bailey, M. J., Bellomo, R., Cooper, D. J., Doig, G. S., Finfer, S. R., & Heyland, D. K. (2012) · Critical Care Medicine · doi:10.1097/ccm.0b013e318255d87e · Cited by 168 · see citing works
Self-citationMancl, E. E., & Muzevich, K. M. (2013) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607112470460 · Cited by 155 · see citing works
Tian, F., Heighes, P. T., Allingstrup, M. J., & Doig, G. S. (2018) · Critical Care Medicine · doi:10.1097/ccm.0000000000003152 · Cited by 147 · see citing works
Self-citationChourdakis, M., Kraus, M. M., Tzellos, T., Sardeli, C., Peftoulidou, M., Vassilakos, D., & Kouvelas, D. (2012) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607110397878 · Cited by 107 · see citing works
Investigating Ketone Bodies as Immunometabolic Countermeasures against Respiratory Viral Infections
Stubbs, B. J., Koutnik, A. P., Goldberg, E. L., Upadhyay, V., Turnbaugh, P. J., Verdin, E., & Newman, J. C. (2020) · Med · doi:10.1016/j.medj.2020.06.008 · Cited by 71 · see citing works
Demehri, F. R., Barrett, M., & Teitelbaum, D. H. (2015) · Nutrition in Clinical Practice · doi:10.1177/0884533615609904 · Cited by 53 · see citing works
Ridley, E. J., & Davies, A. R. (2011) · Nutrition · doi:10.1016/j.nut.2010.10.010 · Cited by 51 · see citing works
Self-citationEnteral nutrition for patients in septic shock: a retrospective cohort study
Rai, S. S., O’Connor, S. N., Lange, K., Rivett, J., & Chapman, M. J. (2010) · Critical Care and Resuscitation · doi:10.1016/s1441-2772(23)01501-6 · Cited by 27 · see citing works
Vest, A. R., DiDomenico, R. J., Lichtenstein, L., Slater, T., Ekpo, E., Damluji, A. A., Bohula, E., Alviar, C. L., on behalf of the American Heart Association Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology, & Council on Cardiovascular and Stroke Nursing (2026) · Circulation · doi:10.1161/cir.0000000000001405 · Cited by 15 · see citing works
Tsai, Y.-C., Yin, C.-H., Chen, J.-S., Chen, Y.-S., Huang, S.-C., & Chen, J.-K. (2024) · Journal of Microbiology, Immunology and Infection · doi:10.1016/j.jmii.2023.12.007 · Cited by 9 · see citing works
- Authors
- Doig, G. S., Heighes, P. T., Simpson, F., Sweetman, E. A., & Davies, A. R.
- Affiliations
- The University of Sydney (AU)
- Royal North Shore Hospital (AU)
- The Alfred Hospital (AU)
- Corresponding author
- Doig, Gordon S.
- Venue
- Intensive Care Medicine
- Published
- 2009-09-24
- Volume
- 35
- Issue
- 12
- Pages
- 2018-2027
- ISSN
- 0342-4642 (ISSN-L)
- 1432-1238
- OpenAlex
- W2079648903
- Cited by
- 464
- References
- 9
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 13 · 2023: 13 · 2022: 21 · 2021: 20 · 2020: 20 · 2019: 35 · 2018: 31 · 2017: 32 · 2016: 30 · 2015: 48 · 2014: 46 · 2013: 37 · 2012: 36
- FWCI
- 3.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Intensive Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Keywords
- early enteral nutrition, critically ill patients, intensive care unit admission, mortality, pneumonia, sepsis, multiple organ failure, bacteremia, regurgitation, trauma patients
- MeSH terms
- Enteral Nutrition, Humans, Intensive Care Units, Mortality, Patient Admission, Time Factors, Wounds and Injuries, Randomized Controlled Trials as Topic, Critical Illness
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
