The DOI matches its Crossref record; 155 of the 155 references it cites were found in a registry or an index; 69 of the 144 sources its claims cite were checked for support.
ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit
Open accessAbstract
Following the new ESPEN Standard Operating Procedures, the previous 2019 guideline to provide best medical nutritional therapy to critically ill patients has been shortened and partially revised. Following this update, we propose this publication as a practical guideline based on the published scientific guideline, but shortened and illustrated by flow charts. The main goal of this practical guideline is to increase understanding and allow the practitioner to implement the Nutrition in the ICU guidelines. All the items discussed in the previous guidelines are included as well as special conditions.
Overview
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Verification
Claims the paper makes
48 No full text of the sources · 28 Supported · 26 Partly supported · 9 Own interpretation · 8 Not checked yet · 5 Own method · 4 Supported so far · 2 Not supported · 2 Couldn’t confirm · 1 Own result · 1 No basis given · accuracy not yet measured
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“The REDOXS study [85], designed as a 2 x 2 factorial trial, generated concerns for several reasons, including the fact that the randomization was associated with higher severity with more organ failures in the GLN groups upon enrollment, largely explaining the higher mortality.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > 33)
What the sources say
- Disputedcites [85] Heyland, 2015, Glutamine and antioxidants in the critically ill patient: a post hoc analysis of a large-scale randomized trial, JPEN - J Parenter Enter Nutr sourceExperimental — accuracy not yet measured
The Discussion (page unavailable) acknowledges a random imbalance in organ failures across groups but says the increased mortality associated with glutamine persisted after adjustment and was independent of the number of organ failures. It explicitly says that the imbalance did not affect the authors’ main inference, contrary to the claim that it largely explains the higher mortality. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Disputed
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In comparing early EN with delayed EN (six studies in ICU patients and four studies including non-ICU patients), and similar to an earlier meta-analysis [13], a reduction of infectious complications with early EN (RR 0.76, CI 0.59, 0.97, p < 0.03) was observed [4].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr source
The commentary to recommendations 3–8 reports the same comparison, study mix, risk ratio, confidence interval, and p-value. It qualifies the finding: the reduction was observed only when studies enrolling non-ICU patients were included, as the citing sentence indicates. (LLM, conf=0.94)
- Partly supportedcites [13] Reintam Blaser, 2017, Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines, Intensive Care Med sourceExperimental — accuracy not yet measured
Question 1B reports fewer infections with early EN than with delayed nutritional intake, but gives RR 0.64 (95% CI 0.46–0.90; P = 0.010) from 11 RCTs, not the claimed RR 0.76 (CI 0.59–0.97; P < 0.03). That comparison also includes delayed oral diet or PN, so it is broader than delayed EN alone. The cited copy does not substantiate the claimed effect estimate or the citing sentence’s study breakdown. (LLM, conf=0.89)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“There were no differences in other outcomes between early and delayed EN.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr source
The commentary to recommendations 3–8 directly compares early with delayed enteral nutrition (EN). It reports fewer infectious complications with early EN when studies including non-ICU patients were included, then states that there were no differences in other outcomes. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Additionally, one study showed possible benefit of a further delay of PN if EN is not possible/ tolerated [14].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [14] Casaer, 2011, Early versus late parenteral nutrition in critically ill adults, N Engl J Med source
The Abstract compares PN started within 48 hours with PN withheld until day 8 when enteral nutrition was insufficient, and reports faster recovery and fewer complications with late initiation. The Subgroup Analyses also report fewer infections with late PN among patients for whom early enteral nutrition was surgically contraindicated. This supports the citing sentence’s hedged claim of a possible benefit from further delay. (LLM, conf=0.89)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Sarcopenia, a decrease in muscle mass and/or function, is frequent in undernourished patients admitted to the ICU [21].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Partly supportedcites [21] Studenski, 2014, The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates, J Gerontol A Biol Sci Med Sci sourceExperimental — accuracy not yet measured
The paper’s Conclusions section describes sarcopenia in terms of muscle mass, strength, and function, supporting the sentence’s definition. Its Background discusses older adults, but neither that section nor the passages retrieved for ICU and undernutrition address how frequent sarcopenia is among undernourished ICU patients. (LLM, conf=0.84)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“This difference did not occur when the amount of energy administered by PN and EN was similar (most recent studies), suggesting that caloric overfeeding may play a role in the infectious complications associated with PN and therefore in the decision process regarding the route, timing and the calorie target should also be taken into account.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [26] Elke, 2016, Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials, Crit Care source
The Results section (Effect of EN versus PN on infectious complications; page not supplied) reports no significant difference in infectious complications across five trials with similar caloric intake in the EN and PN groups. The Discussion (Effect of dissimilar caloric intake) likewise says no treatment effect was observed in those trials and suggests that calorie differences may have influenced the infection findings. (LLM, conf=0.94)
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“However, results of this study revealed the potential harm of nutritional intervention aiming at full, possibly overestimated calorie targets during the acute phase of critical illness.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [14] Casaer, 2011, Early versus late parenteral nutrition in critically ill adults, N Engl J Med source
The Study Procedures describe early parenteral supplementation targeted to 100% of the calculated caloric goal from ICU day 3. The Discussion reports worse morbidity outcomes with early supplementation, while the introduction (p. 507) notes that combining enteral and parenteral nutrition may risk overfeeding. The paper did not establish that its targets were overestimated, but the claim presents that possibility as a qualifier, not a finding. (LLM, conf=0.86)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Handgrip dynamometry can assess muscle function [23].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Could not verifycites [23] Fan, 2010, Inter-rater reliability of manual muscle strength testing in ICU survivors and simulated patients, Intensive Care Med sourceExperimental — accuracy not yet measured
The Methods section (“Manual muscle strength testing,” page unavailable) describes scoring muscle strength with the Medical Research Council scale, and the Discussion addresses manual muscle testing. Searches for “handgrip dynamometry” and grip strength measured with a dynamometer found no passage in our copy stating that handgrip dynamometry can assess muscle function. (LLM, conf=0.75)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Could not verify
Every source the paper cites for this claim was checked and supports it.
In the paper
“Excluding earlier studies (before 2000) attenuates the signal that early EN may reduce infectious complications compared to delaying EN beyond 48 h.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr source
The commentary to recommendations 3–8 states this conclusion directly. It reports fewer infectious complications with early EN in the pooled comparison, but says the signal is attenuated when studies published before 2000 are excluded. (LLM, conf=0.95)
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“In a meta-analysis of studies comparing enteral and parenteral routes independent of timing, Elke et al. [26] found a reduction in ICU infections with EN as compared to PN (RR 0.64, 95% CI 0.48e0.87,p ¼ 0.004, I 2 ¼ 47%).”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [26] Elke, 2016, Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials, Crit Care source
The Results section, under “Effect of EN versus PN on infectious complications,” reports the same reduction and all four statistics for the pooled analysis of 11 trials. The paper calls the outcome “infectious complications” in critically ill patients; it does not label it specifically as infections acquired in the ICU. (LLM, conf=0.93)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“However, this was true only when including studies that also enrolled patients outside of the ICU.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr source
In the Commentary to recommendations 3–8, the guideline reports fewer infectious complications with early versus delayed enteral nutrition, then states that this result held only when studies enrolling patients outside the ICU were included. The excerpt does not provide a page number. (LLM, conf=0.95)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Recent guidelines written by ESPEN [1,2], ASPEN/SCCM [32], the Canadian Critical Care Practice Guideline group [29] and the most recent clinical practice guidelines on early EN in critically ill patients by the ESICM working group on gastrointestinal function [13] were considered when formulating the updated ESPEN recommendations [4].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [1] Kreymann, 2006, ESPEN guidelines on enteral nutrition: intensive care, Clin Nutr source
The cited work is itself an ESPEN guideline on enteral nutrition in intensive care, as its title and “Summary of statements: Intensive care” section identify it. In this sentence, the citation identifies an earlier ESPEN guideline; it is not offered as evidence that the later recommendations considered the other organizations’ guidelines. (LLM, conf=0.92)
- Not checked yetcites [2] Singer, 2009, ESPEN guidelines on parenteral nutrition: intensive care, Clin Nutr source
Checked before — its earlier verdict is held back until a new check runs.
- Not checked yetcites [32] Compher, 2022, Guidelines for the provision of nutrition support therapy in the adult critically ill patient: the American Society for Parenteral and Enteral Nutrition, JPEN - J Parenter Enter Nutr source
Checked before — its earlier verdict is held back until a new check runs.
- Not checked — no full text of the sourcecites [29] Dhaliwal, 2013, The Canadian critical care nutrition guidelines in 2013, Nutr Clin Pract source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Early full feeding independent of the route may be associated with impaired outcomes [33].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Partly supportedcites [33] Reignier, 2023, Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3), Lancet Respir Med sourceExperimental — accuracy not yet measured
The Discussion reports that, among ventilated adults with shock, low calorie and protein intakes were associated with faster readiness for ICU discharge and fewer complications than standard intakes, although 90-day mortality did not differ. Feeding routes were similar between groups and chosen by clinicians, but the cited passages do not establish that the outcome difference was independent of route. The claim also extends beyond the trial’s specific patient population. (LLM, conf=0.84)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“If predictive equations are used, we suggest using hypocaloric nutrition (up to 70% estimated needs), over isocaloric nutrition (70% or greater of estimated needs), in the early phase of acute illness (RR 0.92, 95%CI 0.86e0.99,p ¼ 0.02).”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr source
The guideline’s Grade B commentary recommends hypocaloric nutrition of up to 70% of estimated needs over isocaloric nutrition when predictive equations are used in the early phase of acute illness. It gives the same RR, interval bounds, and p-value as the citing sentence. No page number is provided in our copy. (LLM, conf=0.95)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Undernutrition or over-nutrition is deleterious to outcome according to these large observational studies.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Partly supportedcites [55] Weijs, 2014, Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients, Crit Care sourceExperimental — accuracy not yet measured
The Results (Non-septic overfed and non-overfed patients; page unavailable) associate early energy overfeeding with higher mortality and higher protein intake with lower mortality in non-septic patients. But the Results (Possible underfeeding effect; page unavailable) do not establish that energy underfeeding worsened mortality: excluding seriously energy-underfed patients strengthened the low-protein mortality contrast. The claim also states these observational associations as though they establish harm. (LLM, conf=0.85)
- Partly supportedcites [56] Zusman, 2016, Resting energy expenditure, calorie and protein consumption in critically ill patients: a retrospective cohort study, Crit Care sourceExperimental — accuracy not yet measured
The Conclusions say this observational study suggests that both underfeeding and overfeeding appear harmful in mechanically ventilated, critically ill patients. The claim states harm more definitively and treats undernutrition broadly, whereas the Discussion reports that patients receiving 70% of target calories fared better than those receiving 100%. (LLM, conf=0.85)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Conversely, Reignier et al. observed a better outcome in patients receiving low energy and proteins over 7 days (Nutrirea 3 ¼ ref 33).”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [33] Reignier, 2023, Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3), Lancet Respir Med source
The Procedures section defines the low-calorie and low-protein intervention as lasting the first 7 days after ICU admission. The Discussion reports fewer complications and faster recovery with low intakes than with standard intakes, supporting the broadly stated better outcome. It also specifies that 90-day mortality did not differ. (LLM, conf=0.91)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Our meta-analysis [4] shows that feeding intolerance was more prevalent in the case of gastric feeding in five studies (RR 0.16, 95% CI 0.06e0.45,p ¼ 0.0005).”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr source
The commentary to recommendations 10–12 reports the guideline authors’ own meta-analysis: feeding intolerance was more prevalent with gastric feeding across five studies, with RR 0.16, CI 0.06–0.45, and p=0.0005. This matches the cited sentence. (LLM, conf=0.95)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In fact, early full EN may even be more detrimental than early full PN [34].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Partly supportedcites [34] Pardo, 2023, Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective nutrition cohort study, Crit Care sourceExperimental — accuracy not yet measured
The Discussion (page unavailable) reports that the mortality association persisted for early enteral nutrition but not early parenteral nutrition in a propensity-weighted analysis. It does not establish a comparison of *full* EN with *full* PN; the authors explicitly caution against interpreting the result to mean that high-dose PN is safe while EN is not. (LLM, conf=0.86)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Full EN may be associated with severe complications in shock patients [33,35].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Partly supportedcites [33] Reignier, 2023, Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3), Lancet Respir Med sourceExperimental — accuracy not yet measured
The Findings report less bowel ischaemia and other complications with low rather than standard calorie and protein feeding in adults ventilated for shock, supporting a possible association with complications. But the Procedures and Results show that feeding could be enteral or parenteral; the trial does not establish that full enteral nutrition specifically was responsible. (LLM, conf=0.87)
- Not checked — no full text of the sourcecites [35] Reignier, 2018, Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2), Lancet (London, England) source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Our meta-analysis found no significant advantage in oxygenation for enteral formulae enriched in omega-3 FAs (mainly EPA), gamma-linolenic acid and antioxidants over control groups receiving lipid-rich formulas [4].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Partly supportedcites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr sourceExperimental — accuracy not yet measured
The Commentary to recommendations 26–28 says the guideline’s meta-analysis found a trend toward improved oxygenation with EPA-, GLA-, and antioxidant-enriched enteral formulae. The passage on recommendations 30–32 reports p=0.06, supporting the claim that the oxygenation difference was not statistically significant. Our copy does not establish that the control groups in that meta-analysis received lipid-rich formulae; the commentary describes one comparator as a regular formula. (LLM, conf=0.85)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The use of diabetic-specific enteral formula in ICU patients suffering from Type 2 Diabetes Mellitus decrease the requirement for insulin [70,71]”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [70] Han, 2017, The clinical and economic impact of the use of diabetes-specific enteral formula on ICU patients with type 2 diabetes, Clin Nutr source
- Partly supportedcites [71] Mesejo, 2015, Diabetes-specific enteral nutrition formula in hyperglycemic, mechanically ventilated, critically ill patients: a prospective, open-label, blind-randomized, multicenter study, Crit Care sourceExperimental — accuracy not yet measured
The Abstract Results and Conclusions report lower insulin requirements with diabetes-specific formulas than with a standard formula. But Methods > Patient eligibility enrolled mechanically ventilated ICU patients with hyperglycemia, not specifically patients with Type 2 diabetes; insulin-dependent diabetes was excluded. The claim narrows the finding to a population the study did not separately establish. (LLM, conf=0.87)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Furthermore, the large heterogeneity of the ICU population potentially reduces the external validity of the recommendations, which should be seen as a basis to support decisions made for each patient on an individual basis [6].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > 1. Introduction
What the sources say
- Partly supportedcites [6] Wischmeyer, 2017, Tailoring nutrition therapy to illness and recovery, Crit Care sourceExperimental — accuracy not yet measured
The Conclusions (page unavailable) say that one-size nutrition does not fit all and that nutritional risk and stage of illness should guide care for individual ICU patients. The paper does not specifically say that ICU-population heterogeneity reduces the external validity of recommendations. (LLM, conf=0.82)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Rodas et al. [82] showed a U-shaped association between plasma GLN levels and outcome.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [82] Rodas, 2012, Glutamine and glutathione at ICU admission in relation to outcome, Clin Sci (Lond) source
The Results describe a U-shaped relationship between admission plasma glutamine concentration and six-month mortality in ICU patients. The Discussion explicitly says mortality was increased at both low and very high concentrations. Page numbers are not provided in our copy. (LLM, conf=0.94)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Pradelli et al. [96] conducted a meta-analysis of 24 RCTs comparing fish oil-enriched PN with standard (non-fish oil-enriched) PN in adult patients in the ICU.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [96] Pradelli, 2020, Omega-3 fatty acid-containing parenteral nutrition in ICU patients: systematic review with meta-analysis and cost-effectiveness analysis, Crit Care source
The Results (Study selection and characteristics) state that the meta-analysis compared omega-3 fatty acid-containing PN with standard PN and included 24 randomized controlled trials of patients receiving PN in an ICU. The Methods (Patient population) specify adult ICU patients, and the Methods describe standard PN as not supplemented with omega-3 fatty acids. (LLM, conf=0.95)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Citrate use in continuous veno-venous hemo-diafiltration is also associated with increased carbohydrate load and should be taken into account as a non-nutritional calorie intake [75].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Partly supportedcites [75] Bousie, 2016, Relevance of non-nutritional calories in mechanically ventilated critically ill patients, Eur J Clin Nutr sourceExperimental — accuracy not yet measured
The Results (Patients with renal replacement therapy; page not provided) report that trisodium citrate contributed non-nutritional calories and that patients receiving it had higher total non-nutritional calorie intake. The paper studied continuous veno-venous haemofiltration (CVVH), not specifically haemodiafiltration, and does not describe citrate's contribution as a carbohydrate load. (LLM, conf=0.87)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In the post-hoc analysis of the MetaPlus study [90], administrating GLN, EPA/DHA and antioxidants to critically ill patients, only the change from baseline to day 4 of EPA þ DHA/long chain triglyceride (LCT) ratio was statistically significantly associated with six month mortality (hazard ratio 1.18, 95%CI 1.02e1.35,p ¼ 0.021) suggesting a harmful effect of these nutrients in medical ICU patients.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Partly supportedcites [90] Hofman, 2016, Glutamine, fish oil and antioxidants in critical illness: MetaPlus trial post hoc safety analysis, Ann Intensive Care sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Thus, at 21 days post-extubation, 24% of older patients were feeding tube dependent [113].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Could not verifycites [113] Macht, 2011, Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness, Crit Care sourceExperimental — accuracy not yet measured
The Abstract Results and Discussion report an association between postextubation dysphagia and feeding-tube placement, but not feeding-tube dependence at 21 days in older patients. Searches for “21 days,” “24%,” and feeding-tube dependence found no passage supporting that specific figure or time point. The indexed passages provide section labels but no page numbers. (LLM, conf=0.75)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Could not verify
In the paper
“Petros et al. [47] showed a reduction in infection rate in the study group.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [47] Petros, 2014, Hypocaloric vs normocaloric nutrition in critically ill patients, J Parenter Enteral Nutr source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The recent EAT-ICU study compared the goal-directed group, receiving the EE measured with indirect calorimetry as a caloric target to reach within 24 h to patients receiving standard therapy.The study group also received protein according to urinary nitrogen loss.No advantages or harm were observed in terms of functional outcome, morbidity, or mortality in this RCT [49].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [49] Allingstrup, 2017, Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial, Intensive Care Med source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Medium doses (not low and not high) are associated with the best outcomes [61].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [61] Lin, 2022, Trajectories of protein intake and 28-day mortality in critically ill patients: a secondary analysis of a cluster-randomized controlled trial, Clin Nutr source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Importantly, the dosage of EN was not taken into consideration in this meta-analysis.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Rather than mortality, long-term functional tests might better reflect the benefit of a nutritional policy [11].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > 2. Methodology
What the sources say
- Not checked — no full text of the sourcecites [11] Arabi, 2017, A critical view on primary and secondary outcome measures in nutrition trials, Intensive Care Med source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“The existing nutritional screening tools (nutritional risk screening (NRS) 2002 [8] and the malnutrition universal screening tool (MUST) score [9]) have not been designed specifically for critically ill patients.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > 2. Methodology
What the sources say
- Not checked — no full text of the sourcecites [8] Kondrup, 2003, Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials, Clin Nutr source
- Not matchedcites [9] Ellia, 2003
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This difference did not occur when the amount of energy administered by PN and EN was similar (most recent studies), suggesting that caloric overfeeding may play a role in the infectious complications associated with PN and therefore in the decision process regarding the route, timing and the calorie target should also be taken into account.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“At this stage, the evidence for omega-3 FA-enriched emulsions in non-surgical ICU patients is not sufficient to recommend it as a standalone [76]”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [76] Calder, 2018, Lipids in the intensive care unit: recommendations from the ESPEN expert group, Clin Nutr source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Finally, Stehle et al. [86] in a meta-analysis including only stable patients showed an advantage to administering GLN.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > 33)
What the sources say
- Not checked — no full text of the sourcecites [86] Stehle, 2017, Glutamine dipeptide-supplemented parenteral nutrition improves the clinical outcomes of critically ill patients: a systematic evaluation of randomised controlled trials, Clinical Nutrition ESPEN source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Aggregating all the studies in ICU patients without taking into account the amount of omega-3 FAs or whether they are given as bolus or continuous administration, does not yield any advantage for any formula [87].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [87] Zhu, 2014, Enteral omega-3 fatty acid supplementation in adult patients with acute respiratory distress syndrome: a systematic review of randomized controlled trials with meta-analysis and trial sequential analysis, Intensive Care Med source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“The use of intravenous fat emulsions based solely on soybean oil (rich in 18-carbon omega-6 FA) should be avoided due to their likely pro-inflammatory effects [2].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked yetcites [2] Singer, 2009, ESPEN guidelines on parenteral nutrition: intensive care, Clin Nutr source
Checked before — its earlier verdict is held back until a new check runs.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not checked yet
None of the sources cited for this claim have been checked yet.
In the paper
“but is challenged by the largest RCT revealing no benefit from GLN supplementation in burns [79].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked yetcites [79] Heyland, 2022, A randomized trial of enteral glutamine for treatment of burn injuries, N Engl J Med source
Checked before — its earlier verdict is held back until a new check runs.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not checked yet
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This supports the progressive increase of protein intakes.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In accordance with the Lee et al. meta-analysis, there is no support to recommend higher doses than 1.3 g/kg/d, except for increased muscle mass in individual patients.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The timing of administration has been mainly studied retrospectively or in post hoc analysis [62].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [62] Koekkoek, 2019, Timing of PROTein INtake and clinical outcomes of adult critically ill patients on prolonged mechanical VENTilation: the PROTINVENT retrospective study, Clin Nutr source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Lipid metabolism is modified in critical illness and low plasma triglyceride levels and high-density lipoprotein (HDL) cholesterol levels are associated with improved survival [72].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [72] Green, 2016, Lipid metabolism in critical illness, Curr Opin Clin Nutr Metab Care source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“For now, a gap exists between nutritional practices and the previous guideline [7] and many available studies address only one or at most some of the specific aspects of nutritional therapy.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > 1. Introduction
What the sources say
- Not checked — no full text of the sourcecites [7] Bendavid, 2017, NutritionDay ICU: a 7 year worldwide prevalence study of nutrition practice in intensive care, Clin Nutr source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Finally, enteral GLN was shown to improve body composition and in particular lean body mass in a group of 44 head and neck cancer patients randomized to receive a GLN supplement (30 g daily) for four weeks [81].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [81] Azman, 2015, Enteral glutamine supplementation in surgical patients with head and neck malignancy: a randomized controlled trial, Head Neck source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“In other critically ill patients, the MetaPlus trial [83] showed no advantage in terms of infection of a feeding solution containing additional enteral GLN.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [83] van Zanten, 2014, High-protein enteral nutrition enriched with immune-modulating nutrients vs standard high-protein enteral nutrition and nosocomial infections in the ICU, JAMA source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The determination of the effect of nutrition alone on any possible outcome is complicated by the fact that the severity of illness and the number of comorbidities encountered among adult ICU patients is increasing [5].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > 1. Introduction
What the sources say
- Not checked — no full text of the sourcecites [5] Singer, 2012, Which nutritional regimen for the comorbid complex intensive care unit patient?, World Rev Nutr Diet: S. KARGER AG source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Of note, none of the groups received the planned high dose protein resulting in a mean delivery of 0.9 g/kg/d.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [83] van Zanten, 2014, High-protein enteral nutrition enriched with immune-modulating nutrients vs standard high-protein enteral nutrition and nosocomial infections in the ICU, JAMA source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“In the latter patients, deficiency has been associated with poor outcome including excess mortality, longer length of stay, higher sepsis incidence, and longer mechanical ventilation [110].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked yetcites [110] Zajic, 2014, Vitamin D deficiency in the ICU: a systematic review, Minerva Endocrinol
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“In a RCT, Doig et al. showed that protocoled caloric restriction for 48 h in patients developing hypophosphatemia upon refeeding improved survival despite similar phosphate supplementation in both groups [147].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [147] Doig, 2015, Restricted versus continued standard caloric intake during the management of refeeding syndrome in critically ill adults: a randomised, parallel-group, multicentre, single-blind controlled trial, Lancet Respir Med source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Higher protein intake reaching 1.5e2 g/kg/d may be considered in this population, since there are large protein losses (20e30 g/L of abdominal fluid) [127].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [127] Dickerson, 2017, Protein and calorie requirements associated with the presence of obesity, Nutr Clin Pract source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Small bowel ischemia associated with early (in some cases aggressive) EN via surgical jejunostomy has been reported in several case reports [117,118].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > 46)
What the sources say
- Not checked — no full text of the sourcecites [117] Melis, 2006, Bowel necrosis associated with early jejunal tube feeding, Arch Surg source
- Not checked — no full text of the sourcecites [118] Sarap, 2010, Small bowel necrosis in association with jejunal tube feeding, J Am Acad Physician Assistants source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“An earlier meta-analysis [126] showed that early EN was associated with reduced mortality.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [126] Pan, 2017, The obesity paradox in ICU patients source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Probably not a substantial claim. 25
- It may state two separate claims as one. 67
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“Large observational series including hundreds to thousands of patients have observed that the optimal calorie load associated with the best survival is around 80% of predicted energy needs [53], whereas others suggested no relation between intake and outcome or better outcome with lower energy intakes [54].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [53] Heyland, 2011, Optimal amount of calories for critically ill patients: depends on how you slice the cake, Crit Care Med source
- Disputedcites [54] Bellomo, 2014, Calorie intake and patient outcomes in severe acute kidney injury: findings from the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial, Crit Care sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 0 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Checked by a reasoning model — may be wrong.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
Every source the paper cites for this claim was checked and supports it.
In the paper
“The European Society of Intensive Care Medicine (ESICM) guidelines formulated 17 recommendations favoring initiation of early EN (within 48 h of ICU admission) and seven recommendations favoring delaying EN [13], as summarized in our recommendations No. 8, 11, 12.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [13] Reintam Blaser, 2017, Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines, Intensive Care Med source
The Abstract defines early enteral nutrition as starting within 48 hours and explicitly reports 17 recommendations favoring its initiation and seven favoring delaying enteral nutrition. The Introduction places the guideline in the ICU setting. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Since previous recommendations [1,2], a cut-off of 48 h for the initiation of early nutrition and contraindications to early EN has been better established [13].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [13] Reintam Blaser, 2017, Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines, Intensive Care Med source
The Introduction says earlier guidelines recommended EN within 24–48 hours but did not clearly define reasons to delay it. The Methods define early EN as starting within 48 hours of admission, and the Abstract lists conditions in which the guideline suggests delaying EN. The guideline notes that these recommendations are weak because the evidence is limited. (LLM, conf=0.89)
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“In meta-analyses performed for the ESICM guidelines, early EN reduced infectious complications in unselected critically ill patients, in patients with severe acute pancreatitis, and after gastrointestinal surgery, whereas no evidence of superiority for early PN or delayed EN over early EN was detected in any of the sub-questions.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [13] Reintam Blaser, 2017, Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines, Intensive Care Med source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Frailty has been suggested as the burden of comorbid disease, is well defined [15] and can be diagnosed by clinical observations or by complementary examinations [16].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [15] Fried, 2001, Frailty in older adults: evidence for a phenotype, The Journals of Gerontology Series A: Biological Sciences and Medical Sciences source
- Supportedcites [16] Cederholm, 2015, Diagnostic criteria for malnutrition – an ESPEN consensus statement, Clin Nutr source
The citation to this source is attached to “is well defined,” not to the subsequent claim about diagnosis, which cites [16]. The Introduction describes frailty as a well-established concept and says the statement does not challenge its definition. (LLM, conf=0.88)
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Patients with low muscle mass found at admission by computerized tomography have a higher length of stay and higher mortality [25].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Partly supportedcites [25] Braunschweig, 2014, Exploitation of diagnostic computed tomography scans to assess the impact of nutrition support on body composition changes in respiratory failure patients, JPEN - J Parenter Enter Nutr sourceExperimental — accuracy not yet measured
The CT Image Analysis section (page unavailable) confirms that the study quantified skeletal muscle using CT scans. The introductory text says malnourished patients generally have longer hospitalizations and higher mortality, but the Results (page unavailable) report muscle changes between scans, not an association between low muscle mass on an admission CT and either outcome. (LLM, conf=0.82)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“NUTRIC (¼ nutritional risk in critically ill) is a novel risk assessment tool merely based on the severity of disease was proposed [10].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > 2. Methodology
What the sources say
- Partly supportedcites [10] Heyland, 2011, Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool, Crit Care sourceExperimental — accuracy not yet measured
The Introduction identifies NUTRIC as a novel risk-assessment tool. But the Results describe a final score with six variables, not one based merely on disease severity; these include age and other factors alongside APACHE II and SOFA scores. The Results also say that weight loss and oral intake were excluded from the final score. (LLM, conf=0.90)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Despite the fact that bolus administration is significantly different from continuous feeding in healthy individuals, it significantly increases gastric volume and superior mesenteric artery blood volume in critically ill patients [30], although these differences are not always translated into clinical advantages.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Partly supportedcites [30] Chowdhury, 2016, Effects of bolus and continuous nasogastric feeding on gastric emptying, small bowel water content, superior mesenteric artery blood flow, and plasma hormone concentrations in healthy adults: a randomized crossover study, Ann Surg sourceExperimental — accuracy not yet measured
The Results (Gastric Liquid Volume; Superior Mesenteric Artery Blood Velocity and Flow; pages not supplied) report higher gastric liquid volume and superior mesenteric artery blood flow with bolus feeding. The study concerns healthy adults, not critically ill patients, and measures arterial flow rather than superior mesenteric artery blood volume. The Discussion explicitly cautions against drawing conclusions about tube-feeding effects in clinical settings. (LLM, conf=0.90)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Meanwhile, following the screening process, the malnutrition assessment requires the association of a phenotype (weight loss %, BMI, decrease in appetite, and/or low muscle mass) and an etiology e.g.critical illness [17] (GLIM (Global Leadership Initiative on Malnutrition) criteria).”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Partly supportedcites [17] Cederholm, 2019, GLIM criteria for the diagnosis of malnutrition - a consensus report from the global clinical nutrition community, Journal of cachexia, sarcopenia and muscle sourceExperimental — accuracy not yet measured
The Results section (‘Approach to using combined phenotypic and etiologic criteria’) says GLIM diagnosis requires at least one phenotypic and one etiologic criterion. It lists weight loss, reduced BMI, and reduced muscle mass as phenotypic, but places reduced food intake or assimilation under etiologic criteria; the citing sentence incorrectly lists decreased appetite as phenotypic. (LLM, conf=0.88)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Casaer et al. [14] observed that early (supplemental or exclusive) PN is associated with increased morbidity including prolonged ICU dependency and mechanical ventilation, and increased infection rate and need for renal replacement therapy.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Partly supportedcites [14] Casaer, 2011, Early versus late parenteral nutrition in critically ill adults, N Engl J Med sourceExperimental — accuracy not yet measured
The Discussion reports that late PN was associated with fewer ICU infections and shorter ICU stays, mechanical ventilation, and renal-replacement therapy than early PN. However, Table 2 (Study Intervention) shows no meaningful difference in the proportion requiring renal-replacement therapy (8.9% early vs. 8.6% late; P=0.77). The claim is supported for longer therapy, not increased need for it. (LLM, conf=0.90)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“However, all issued recommendations were weak due to the low quality of evidence, with most of them finally based on expert opinion [13].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [13] Reintam Blaser, 2017, Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines, Intensive Care Med source
The Abstract states that all recommendations are weak because of low-quality evidence. Table 2 (under Question 1; page not available in our copy) labels most recommendations as based on expert opinion, supporting the citing sentence’s stronger quantifier. (LLM, conf=0.94)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Five studies were identified and meta-analysis found a significant reduction in diarrhea with continuous versus bolus administration (RR 0.42, 95%CI 0.19e0.91,p ¼ 0.03), whereas no difference was identified in other outcomes [4].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr source
The commentary to Recommendation 9 states that five studies were identified and that the guideline authors’ meta-analysis found less diarrhea with continuous than bolus feeding (RR 0.42, CI 0.19–0.91, p=0.03), with no difference in other outcomes. (LLM, conf=0.95)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“When comparing early EN with early PN (six studies in ICU patients and seven studies with non-ICU patients included) a reduction of infectious complications with EN (RR 0.50, 95%CI 0.37e0.67,p ¼ 0.005), as well as shorter ICU (RR -0.73, 95%CI -1.30 to À0.16, p ¼ 0.01) and hospital stay (RR -1.23, 95%CI -2.02 to À0.45, p ¼ 0.002) was observed, while mortality was not different [4].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr source
The Commentary to recommendations 3–8 directly reports the early-EN-versus-early-PN comparison, including six studies in ICU patients and seven studies also including non-ICU patients. It gives the cited infection, ICU-stay, and hospital-stay estimates and states that mortality was not different. The supplied passage has no page number. (LLM, conf=0.95)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Muscle mass can be evaluated by ultrasound [18], computerized tomography scan [19], or bioelectric impedance analysis (BIA) [20].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [18] Wischmeyer, 2015, Winning the war against ICU-acquired weakness: new innovations in nutrition and exercise physiology, Crit Care source
The citation to this paper, [18], is attached to ultrasound, not to CT or BIA. In “Are checklists and bundles the answer after the ICU?”, the paper says routine ultrasound can accurately predict lean body mass. (LLM, conf=0.94)
- Supportedcites [19] Looijaard, 2016, Skeletal muscle quality as assessed by CT-derived skeletal muscle density is associated with 6-month mortality in mechanically ventilated critically ill patients, Crit Care source
The citation [19] is attached specifically to computerized tomography, not to ultrasound or BIA. In Methods > CT scan analysis (page not provided), the paper describes using CT scans to measure skeletal muscle area, supporting CT as a way to evaluate muscle mass. (LLM, conf=0.93)
- Not checked — no full text of the sourcecites [20] Thibault, 2016, Fat-free mass at admission predicts 28-day mortality in intensive care unit patients: the international prospective observational study Phase Angle Project, Intensive Care Med source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A better survival was observed in patients in whom EFI was resolved within 72 h, more likely in patients receiving prokinetics [38].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [38] Vijayaraghavan, 2022, Reversal of feed intolerance by prokinetics improves survival in critically ill cirrhosis patients, Dig Dis Sci source
The Abstract Results report better 7-day survival among patients whose feed intolerance resolved within 72 hours (65.5% versus 36%). The Results > Secondary Outcomes report that resolution within 72 hours was more frequent with metoclopramide or erythromycin than with placebo. (LLM, conf=0.94)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“A larger database analysis suggested that energy intake is associated with significantly improved survival when it is close to measured EE [55] or between 70 and 100% of the repeatedly measured resting EE [56].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Partly supportedcites [55] Weijs, 2014, Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients, Crit Care sourceExperimental — accuracy not yet measured
The Results (Possible underfeeding effect; page unavailable) report lower mortality odds at 90–100% of measured EE, but that comparison is between protein-intake groups, not a finding that energy intake near EE independently improves survival. The Discussion (Overfeeding; page unavailable) explicitly says improved energy intake with insufficient protein was not associated with lower mortality. The separate 70–100% claim is attached to citation [56], not this source. (LLM, conf=0.84)
- Partly supportedcites [56] Zusman, 2016, Resting energy expenditure, calorie and protein consumption in critically ill patients: a retrospective cohort study, Crit Care sourceExperimental — accuracy not yet measured
The Results report the lowest 60-day mortality at 70% of administered calories to measured resting energy expenditure (REE). They also report increasing mortality as intake rises above 70%, so the cited paper does not support improved survival across the full 70–100% range. The Discussion says many patients had repeated measurements, not that REE was repeatedly measured for every patient. (LLM, conf=0.88)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Postpyloric EN has been associated with a decrease in ventilator acquired pneumonia in several earlier meta-analyses, but this benefit did not translate into decreases in length of ventilation, ICU or hospital stay, or mortality [4].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr source
The commentary to recommendations 10–12 states the claim directly: it reports that earlier meta-analyses associated postpyloric EN with less ventilator-acquired pneumonia, without reductions in ventilation duration, ICU or hospital stay, or mortality. No page number is provided in the supplied passage. (LLM, conf=0.95)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Our meta-analysis focused only on studies using indirect calorimetry found a trend (RR 1.28, 95%CI 0.98e1.67,p ¼ 0.07) to improved short-term mortality when using indirect calorimetry to identify the energy target, compared to hypocaloric regimens but there were no significant differences in long term mortality, infection or length of stay [4].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“We observed a trend for less pneumonia (eleven studies) (RR 0.75, 95%CI 0.55e1.03,p ¼ 0.07) in patients treated with postpyloric feeding with no differences in mortality (twelve studies), diarrhea (seven studies) or ICU length of stay.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr source
The commentary to recommendations 10–12 reports the guideline authors’ meta-analysis and gives the same trend for less pneumonia with postpyloric feeding (11 studies; RR 0.75, CI 0.55–1.03; p=0.07). It also reports no differences in mortality, diarrhea, or ICU length of stay. (LLM, conf=0.95)
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“However, RCTs did not confirm the expected benefit of higher protein intakes alone, or combined with physical activity or energy [37,54,58].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [37] Murthy, 2022, Higher versus lower enteral calorie delivery and gastrointestinal dysfunction in critical illness: a systematic review and meta-analysis, Clin Nutr source
- Partly supportedcites [54] Bellomo, 2014, Calorie intake and patient outcomes in severe acute kidney injury: findings from the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial, Crit Care sourceExperimental — accuracy not yet measured
The Abstract Conclusions report that greater daily calorie intake was not associated with improved outcomes in patients with severe acute kidney injury. But the Methods (Daily calorie intake) say nutrition was not assigned by protocol and calories excluded protein nitrogen; the Discussion (Study strengths and limitations) calls these observational findings from a trial of kidney-replacement therapy. This paper therefore does not establish that an RCT found no benefit from higher protein intake, alone or in combination with activity or energy. (LLM, conf=0.87)
- Not checked — no full text of the sourcecites [58] Dvir, 2006, Computerized energy balance and complications in critically ill patients: an observational study, Clin Nutr source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“If indirect calorimetry is not available, calculation of REE from VCO 2 only obtained from ventilators (REE ¼ VCO 2 x 8.19) has been demonstrated to be more accurate than equations [50] but less accurate than indirect calorimetry [51].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [50] Stapel, 2015, Ventilator-derived carbon dioxide production to assess energy expenditure in critically ill patients: proof of concept, Crit Care source
The Key messages give the bedside formula, 8.19 × ventilator-derived VCO2, and say it is more precise than predictive equations. The Abstract Results report higher accuracy rates than several predictive equations. The citing sentence assigns the comparison with indirect calorimetry to a different citation. (LLM, conf=0.93)
- Partly supportedcites [51] Oshima, 2017, Can calculation of energy expenditure based on CO(2) measurements replace indirect calorimetry?, Crit Care sourceExperimental — accuracy not yet measured
The Discussion reports that VCO₂-based estimates met the 5% accuracy standard in only 46% of cases and concludes that they should not replace energy expenditure measured by indirect calorimetry. However, the Methods and Strengths and weaknesses sections specify that this study obtained VCO₂ from an indirect calorimeter, not a ventilator. It therefore supports the accuracy comparison, but not as a direct demonstration for ventilator-derived VCO₂. (LLM, conf=0.86)
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The latter performed an extensive review of the literature, multiple metaanalyses, six web-seminars and utilized the GRADE methodology, evidence to decision framework and Delphi methodology.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Partly supportedcites [13] Reintam Blaser, 2017, Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines, Intensive Care Med sourceExperimental — accuracy not yet measured
The Methods section (page unavailable) describes systematic reviews, and the Results section documents multiple meta-analyses; the Question 1 section also refers to two Delphi rounds and grades the certainty of evidence. Our copy does not substantiate the claim of six web-seminars or identify an evidence-to-decision framework. The explicit statement that the authors used the GRADE approach appears only in the abstract, which is not evidence for this verdict. (LLM, conf=0.83)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Recently the analysis of a large data base including 1171 patients with indirect calorimetry data [56] confirmed that under-and overfeeding were both deleterious, and that the optimal amount appeared to be between 70 and 100% of measured EE.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Partly supportedcites [56] Zusman, 2016, Resting energy expenditure, calorie and protein consumption in critically ill patients: a retrospective cohort study, Crit Care sourceExperimental — accuracy not yet measured
The Abstract Results report 1,171 patients, and the Results describe a U-shaped association between calorie intake and 60-day mortality. But the lowest observed mortality was at 70% of measured resting energy expenditure, not throughout a 70–100% range. The Discussion also cautions that this observational study cannot establish that under- or overfeeding caused harm, so 'confirmed' is too strong. (LLM, conf=0.88)
hedgeddirectn = 1,171- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“A higher GLN requirement in burn patients is explained by exudative losses: analysis of burn exudates shows that GLN is lost in larger amounts than any other amino acid [80].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Partly supportedcites [80] Gonzalez, 2016, Effect of human burn wound exudate on Pseudomonas aeruginosa virulence, mSphere sourceExperimental — accuracy not yet measured
The Results (Physicochemical characterization of burn wound exudate; page not provided) say glutamine was the only amino acid at a reduced concentration in both exudate and patient serum relative to clinical reference values. The Discussion links low glutamine in exudate to depletion in burn patients. Neither passage establishes that more glutamine is lost through exudate than any other amino acid or measures the resulting increase in glutamine requirement. (LLM, conf=0.86)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“This lipid solution contains 1.1 kcal/mL and can provide a large energy load exceeding nutritional support [75].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Partly supportedcites [75] Bousie, 2016, Relevance of non-nutritional calories in mechanically ventilated critically ill patients, Eur J Clin Nutr sourceExperimental — accuracy not yet measured
The Introduction states that propofol contains 1.1 kcal/mL and calculates that an infusion of 20 mL/h provides 528 kcal over 24 hours. The Conclusions say non-nutritional calories can be substantial in individual patients, but the paper does not establish that propofol’s energy contribution exceeds nutritional support. (LLM, conf=0.86)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Propofol is a source of fatty acids.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Recent stable isotope studies [63,64] demonstrate that amino acid conversion is improved with time, allowing an increase in whole body protein production only after the early period of the acute phase, even increasing further in the post-acute phase.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Partly supportedcites [63] Gamrin-Gripenberg, 2018, An attenuated rate of leg muscle protein depletion and leg free amino acid efflux over time is seen in ICU long-stayers, Crit Care sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
- Partly supportedcites [64] Deutz, 2021, Comprehensive metabolic amino acid flux analysis in critically ill patients, Clin Nutr sourceExperimental — accuracy not yet measured
The Discussion (page unavailable) reports increased whole-body protein synthesis in ICU patients, measured using stable isotope tracers. The Methods (page unavailable) say patients were studied 4 or 14 days after admission, but the paper does not show that amino acid conversion improves over time or that protein synthesis rises only after the early acute phase and further in the post-acute phase. (LLM, conf=0.86)
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“In critically ill ICU patients, fish oil was associated with reductions in infections (RR 0.65, 95% CI 0.46e0.94),ICU LOS (À2.14 days, 95% CI -3.89 to À0.40), and hospital length of stay (À3.98 days, 95% CI -6.90 to À1.06), but with a non-significant reduction in 30-day mortality in all ICU patients (RR 0.90, 95% CI 0.69e1.16).”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [96] Pradelli, 2020, Omega-3 fatty acid-containing parenteral nutrition in ICU patients: systematic review with meta-analysis and cost-effectiveness analysis, Crit Care source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“In major burns, studies include a limited number of patients: nevertheless, the existing randomized trials have repeatedly demonstrated that GLN (and its precursor ornithine a-ketoglutarate) has beneficial effects in major burn injuries, reducing infectious complications (mainly gram negative infections) and also mortality [4].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr source
The Commentary to recommendations 26–28 (page not specified in our copy) states that randomized trials in major burns found benefits from GLN and ornithine α-ketoglutarate, including fewer infectious complications—mainly gram-negative infections—and lower mortality. It also notes that the studies included limited numbers of patients. (LLM, conf=0.95)
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Our meta-analysis including three studies showed a decrease in length of stay (RR -0.47, 95%CI -7.57 to À1.71, p ¼ 0.002), and a trend for decrease in mortality (RR 0.69, 95%CI 0.39e1.23,p ¼ 0.21), but no difference in incidence of pneumonia when early EN was administered rather than early PN [4].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“High-quality RCTs evaluating high doses of selenium [99], vitamin D [100,101], vitamin C [102e108], and combinations of vitamin C and thiamine [109], revealed no hard clinical benefit of such interventions.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [99] Manzanares, 2016, High-dose intravenous selenium does not improve clinical outcomes in the critically ill: a systematic review and meta-analysis, Crit Care source
Citation [99] is attached to selenium, not to the other nutrients in the sentence. In Results > Subgroup analyses (page unavailable), the higher-quality selenium trials showed no significant mortality benefit; the paper also reports no overall mortality benefit. The source is a meta-analysis of RCTs rather than a single RCT. (LLM, conf=0.93)
- Not checked yetcites [100] Han, 2021, Effect of early high-dose vitamin D3 repletion on cognitive outcomes in critically ill adults, Chest source
Checked before — its earlier verdict is held back until a new check runs.
- Supportedcites [101] Ginde, 2019, Blood Institute, Petal Clinical Trials Network. Early high-dose vitamin D(3) for critically ill, vitamin D-deficient patients, N Engl J Med source
For the vitamin D portion of the citing sentence, the Discussion reports that this randomized trial found no advantage from high-dose vitamin D3 over placebo in mortality or other clinically important outcomes among critically ill, vitamin D-deficient patients. The supplied passage does not give a page number; the other interventions are attributed to other citations. (LLM, conf=0.93)
- Not matchedcites [102e108]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Reduced infection rates in late vs early PN were observed (29.9% vs. 40.2%,p ¼ 0.01) with no difference in any mortality outcomes, whereas all these patients received virtually no EN during the seven study days [14].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Partly supportedcites [14] Casaer, 2011, Early versus late parenteral nutrition in critically ill adults, N Engl J Med sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Oral intake is frequently prescribed in the intensive care setting varying from 25 to 45% of the patients in the first four days, but does not reach the energy or protein requirements according to the Nutrition Day ICU survey [6].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Partly supportedcites [6] Wischmeyer, 2017, Tailoring nutrition therapy to illness and recovery, Crit Care sourceExperimental — accuracy not yet measured
The Background section on ICU nutrition delivery (page unavailable) reports that patients receive substantially less energy and protein than recommended, supporting the general point about unmet requirements. It does not report oral intake being prescribed for 25–45% of patients in the first four days or attribute those figures to a Nutrition Day ICU survey; its figures concern overall delivery over the first 12 days from the International Nutrition Survey. (LLM, conf=0.86)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“We performed a meta-analysis of EN vs no nutrition within the first 48 h, which did not reveal clear benefit of EN in this subgroup of patients, but a trend towards fewer infectious complications was observed (RR 0.47, 95%CI 0.20e1.07,p ¼ 0.07) [4].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Recent evidence tends to show that persistently low zinc concentrations might become an important biomarker of adverse outcomes in sepsis [97].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [97] Hoeger, 2017, Persistent low serum zinc is associated with recurrent sepsis in critically ill patients - a pilot study, PLoS One source
The Abstract reports that lower serum zinc was associated with recurrent sepsis and that lower levels at admission were seen in patients with more organ dysfunction and higher mortality. The Discussion describes serum zinc as a potentially useful biomarker while cautioning that this exploratory pilot study does not establish causation. The claim's tentative wording reflects those limits. (LLM, conf=0.91)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Oral intake is impaired after extubation and a high incidence of swallowing dysfunction has been described (between 10 and 67.5%, with a mean around 50%, despite different timing and methods used for assessing the dysphagia) [112].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Supportedcites [112] Tsai, 2016, Swallowing dysfunction following endotracheal intubation: age matters, Medicine (Baltim) source
The Discussion reports that prior studies found postextubation swallowing dysfunction rates of 10%–67.5%, hovering around 50%, despite differences in assessment timing and methods. The Results section also documents delayed resumption of total oral intake after extubation in this study’s participants. (LLM, conf=0.94)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
In the paper
“It appears that among all the screening tools, NRS 2002 and MUST have the strongest predictive value for mortality, and they are the easiest and quickest to calculate [12].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > 2. Methodology
What the sources say
- Not checked — no full text of the sourcecites [12] Lew, 2016, Association between malnutrition and clinical outcomes in the intensive care unit: a systematic review, J Parenter Enteral Nutr source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“This loss of muscle may be considered as frailty and is associated with a prolonged hospital stay, and a decrease in quality of life and functional capacity [22].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [22] Detsky, 1984, Evaluating the accuracy of nutritional assessment techniques applied to hospitalized patients: methodology and comparisons, J Parenter Enteral Nutr source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“On the other hand, a too low intake, below 50%, was associated in retrospective studies with a worse clinical outcome.may lead to severe calorie debt and empty the energy reserves, reduce lean body mass and may increase infectious complications [58,59].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [58] Dvir, 2006, Computerized energy balance and complications in critically ill patients: an observational study, Clin Nutr source
- Not checked — no full text of the sourcecites [59] Villet, 2005, Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients, Clin Nutr source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Numerous metaanalyses have demonstrated the poor value of predictive equations [43,44], variability that is increased because body weight remains difficult to accurately assess [45].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [43] Frankenfield, 2008, Analysis of estimation methods for resting metabolic rate in critically ill adults, J Parenter Enteral Nutr source
- Not checked — no full text of the sourcecites [44] Tatucu-Babet, 2015, Prevalence of underprescription or overprescription of energy needs in critically ill mechanically ventilated adults as determined by indirect calorimetry, J Parenter Enteral Nutr source
- Not checked — no full text of the sourcecites [45] Graf, 2017, Energy expenditure in mechanically ventilated patients: the weight of body weight, Clin Nutr source
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Berger & Pichard observe an increase in mortality in the group of patients receiving energy close to the prescribed recommended energy intake [52].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [52] Berger, 2015, Understanding the Causes of Death in INTACT by Braunschweig et al, J Parenter Enteral Nutr source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Early full feeding causes overfeeding as it adds to the endogenous energy production which amounts to 500e1400 kcal/d and can lead to.deleterious effects such as increased length of stay, ventilation duration and infection rates [57].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [57] Iapichino, 2006, Metabolic treatment of critically ill patients: energy balance and substrate disposal, Minerva Anestesiol
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The pilot TICACOS study [46] showed that such a strategy was associated with an improvement in 60 day survival in the per protocol study, but also to an increase in length of ventilation, infections and length of stay related to the calorie overload and positive energy balance due to non-nutritional energy intakes.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [46] Singer, 2011, The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients, Intensive Care Med source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The predictive equations are associated with significant inaccuracy (up to 60%), leading to over or under evaluation of the needs and inducing over or underfeeding [42].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [42] Zusman, 2019, Predictive equations versus measured energy expenditure by indirect calorimetry: a retrospective validation, Clin Nutr source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Energy-dense feed delivery is associated with increased prokinetic use, but does not affect other outcomes [37].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [37] Murthy, 2022, Higher versus lower enteral calorie delivery and gastrointestinal dysfunction in critical illness: a systematic review and meta-analysis, Clin Nutr source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Heidegger et al. [48] measured EE at day 3 and adapted the energy intake accordingly, comparing supplemental PN from day four to an EN only group.The intervention group had a lower late nosocomial infection rate after day 9.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [48] Heidegger, 2013, Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial, Lancet source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The recruited patients' energy intake was very variable, although similar in the groups (around 14 kcal/kg/d) receiving high and low-dose proteins.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [60] Heyland, 2023, The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicentre, pragmatic, registry-based randomised trial, Lancet (London, England) source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Recently [60], a comparison between 1.6 ± 0.5 g/kg/d compared with 0.9 ± 0.3 g/kg/d administered protein did not find any significant difference in outcomes, but an increased mortality in patients with acute kidney injury randomized to high protein intakes.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [60] Heyland, 2023, The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicentre, pragmatic, registry-based randomised trial, Lancet (London, England) source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A meta-analysis did not reveal any benefit of omega-3 FA, but there was a trend towards increase in PO 2 /FiO 2 with intervention (RR 22.59, 95%CI -0.88 -46.05, p ¼ 0.06).”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“There are no PN studies with or without micronutrients.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
In the paper
“BIA can assess body composition in a stable patient not suffering from fluid compartment shifts and phase angle [24] is useful in the evaluation of the prognosis of critically ill patients.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked yetcites [24] Reis de Lima e Silva, 2014, Phase angle as an indicator of nutritional status and prognosis in critically ill patients, Nutr Hosp
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“A definition of acute critical illnessassociated malnutrition still needs to be developed [8].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [8] Kondrup, 2003, Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials, Clin Nutr source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This limited amount of data suggests that bolus and continuous enteral feeding can achieve the same target without an increase in side effects in any of these routes.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“According to the American Society for Parenteral and Enteral Nutrition (ASPEN) recommendations [27], patients at increased risk for aspiration may be identified by a number of factors, including inability to protect the airways, support with mechanical ventilation, age >70 years, reduced level of consciousness, poor oral care, inadequate nurse:patient ratio, supine positioning, neurologic deficits”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [27] Taylor, 2016, Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient, Crit Care Med source
- Not checked — no full text of the sourcecites [28] Mahadeva, 2008, Transnasal endoscopic placement of nasoenteric feeding tubes: outcomes and limitations in non–critically ill patients, Nutr Clin Pract source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, recent randomized controlled trials (RCTs) do not demonstrate a clear advantage of EN over PN, and the observed benefit of EN in earlier studies may be due to the higher energy and amino acid/protein content provided by PN compared to EN.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Rests on an assumption: Recent randomized controlled trials do not demonstrate a clear advantage of EN over PN.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These findings may be related to the specific study protocol, the patients' characteristics and the large amounts of energy administered under guidance of predictive equations instead of indirect calorimetry.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Finally, bolus feeding could provide a greater stimulus for protein synthesis [31].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [31] Patel, 2018, Intermittent versus continuous feeding in critically ill adults, Curr Opin Clin Nutr Metab Care source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, in all these studies, calorie delivery was lower than recommended/prescribed or the studies were not targeted to this parameter.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“As postpyloric tube placement requires expertise, is commonly associated with some time delay, and is considered less physiological compared to gastric EN, the routine use of the postpyloric route is currently not justified.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It should be considered that postpyloric tube placement requires expertise, is probably less physiologic compared to gastric EN, and could possibly be harmful in cases of GI motility problems distal to the stomach.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Since many of the authors of the current guidelines are also co-authors of the ESICM guidelines, a decision was made to endorse the respective recommendations related to early enteral feeding.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Moreover, postpyloric feeding could possibly be harmful in cases of gastrointestinal motility problems distal to the stomach.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
In the paper
“The original guideline was developed according to the standard operating procedure (SOP) for ESPEN guidelines and consensus papers [3].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > 2. Methodology
What the sources say
- Not checked — no full text of the sourcecites [3] Bischoff, 2015, Standard operating procedures for ESPEN guidelines and consensus papers, Clin Nutr source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All recommendations were agreed in a multistage consensus process, which resulted in a percentage of agreement (%).”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > 2. Methodology
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Lipid metabolism is modified in critical illness and low plasma triglyceride levels and high-density lipoprotein (HDL) cholesterol levels are associated with improved survival [72].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [72] Green, 2016, Lipid metabolism in critical illness, Curr Opin Clin Nutr Metab Care source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Endogenous glucose production is increased and does not decrease when nutrients and insulin are administered as compared with healthy conditions [68].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [68] Thorell, 2004, Intensive insulin treatment in critically ill trauma patients normalizes glucose by reducing endogenous glucose production, J Clin Endocrinol Metabol source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Mechanistic understandings of the action of omega-3 FA from fish oil have advanced [91], and positive effects of fish oil on organ function (kidney, liver, muscle) have been reported [92].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked yetcites [91] Calder, 2020, Lipids in parenteral nutrition: biological aspects, JPEN - J Parenter Enter Nutr source
Checked before — its earlier verdict is held back until a new check runs.
- Not checked — no full text of the sourcecites [92] Singer, 2023, The role of omega-3 polyunsaturated fatty acids in the intensive care unit, Curr Opin Clin Nutr Metab Care source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not checked yet
In the paper
“Excessive glucose based energy provision is associated with hyperglycemia, enhanced CO 2 production, enhanced lipogenesis, increased insulin requirements and no advantage in protein sparing in comparison with lipid based energy provision [69].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [69] Tappy, 1998, Effects of isoenergetic glucose-based or lipid-based parenteral nutrition on glucose metabolism, de novo lipogenesis, and respiratory gas exchanges in critically ill patients, Crit Care Med source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Since the 1990s, many studies have shown benefits in terms of infectious complication reduction, lower mortality and reduction of hospital costs recently confirmed in an analysis including RCTs performed after 2000, using GLN as part of nutrition support [84].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > 33)
What the sources say
- Not checked — no full text of the sourcecites [84] Pasin, 2013, Glutamine and antioxidants in critically ill patients, N Engl J Med source
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The guideline process summary and dissemination were funded exclusively by ESPEN.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > 2. Methodology
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Administration of marked amounts of carbohydrates and lipids can lead to hyperglycemia and liver function test abnormalities while high fat administration can lead to lipid overload, and especially unsaturated fat to impaired lung function and immune suppression [73].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [73] Elwyn, 1993, Protein and energy requirements: effect of clinical state, Clin Nutr source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Glenn and Wischmeyer [88] analyzed separately the studies administering omega-3 FAs as a bolus or in a continuous manner and found that continuous administration improved length of stay and length of ventilation; in contrast, bolus administration had no advantage.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [88] Glenn, 2014, Enteral fish oil in critical illness, Curr Opin Clin Nutr Metab Care source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Administration of marked amounts of carbohydrates and lipids can lead to hyperglycemia and liver function test abnormalities while high fat administration can lead to lipid overload, and especially unsaturated fat to impaired lung function and immune suppression [73].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [73] Elwyn, 1993, Protein and energy requirements: effect of clinical state, Clin Nutr source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Continuous renal replacement therapy for more than two weeks is a new cause of acute micronutrient deficiencies and particularly of severe copper deficiency that may explain life-threatening complications in patients requiring this therapy [98].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [98] Ben-Hamouda, 2017, Massive copper and selenium losses cause life-threatening deficiencies during prolonged continuous renal replacement, Nutrition source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“One larger retrospective study comparing early EN via surgical jejunostomy with early PN resulted in less life-threatening complications and a shorter postoperative hospital stay [116].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [116] Fujita, 2012, Early enteral nutrition reduces the rate of life-threatening complications after thoracic esophagectomy in patients with esophageal cancer, Eur Surg Res source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“A recent early calorie restriction study showed that electrolyte alterations were less likely to occur with a cautious introduction of feeding and this was confirmed by a retrospective study [149].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [149] Olthof, 2018, Impact of caloric intake in critically ill patients with, and without, refeeding syndrome: a retrospective study, Clin Nutr source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Recently, 29% of 446 ICU patients had prolonged post-extubation swallowing disorder at discharge and some post-extubation swallowing disorder has been shown four months after discharge [114].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [114] Macht, 2014, Swallowing dysfunction after critical illness, Chest source
plainn = 446- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Parenteral and enteral feeding preparations differ in that commercially available PN solutions contain no micronutrients for stability reasons: this requires their separate prescription [2].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked yetcites [2] Singer, 2009, ESPEN guidelines on parenteral nutrition: intensive care, Clin Nutr source
Checked before — its earlier verdict is held back until a new check runs.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not checked yet
In the paper
“Fan et al. [125] compared three groups: early EN, early PN and EN followed by supplemental PN.Complications and mortality were significantly decreased and nutritional status and clinical outcomes were improved in the early EN þ supplemental PN group.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [125] Fan, 2016, Early enteral combined with parenteral nutrition treatment for severe traumatic brain injury: effects on immune function, nutritional status and outcomes, Chin Med Sci J source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Kompan et al. [124] compared early EN to early PN followed by EN in multiple trauma patients and found a significant decrease in pneumonia and length of stay, but not in hospital stay and mortality.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [124] Kompan, 2004, Is early enteral nutrition a risk factor for gastric intolerance and pneumonia?, Clin Nutr source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Providing micronutrients to include the full range of trace elements and vitamins is an integral part of nutritional support as stated in the 2009 guidelines [2].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked yetcites [2] Singer, 2009, ESPEN guidelines on parenteral nutrition: intensive care, Clin Nutr source
Checked before — its earlier verdict is held back until a new check runs.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Not checked yet
In the paper
“Most trauma patients are not malnourished on admission (6% SGA C), but may become malnourished during ICU stay (increase in SGA B) [123].”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
What the sources say
- Not checked — no full text of the sourcecites [123] Goiburu, 2006, The impact of malnutrition on morbidity, mortality and length of hospital stay in trauma patients, Nutr Hosp
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper relies on this without support.
No specific nutritional score for use in the ICU has been validated thus far.
“No specific nutritional score for use in the ICU has been validated thus far.”
The paper relies on this without support.
Validation of the utility of NRS 2002 and MUST for daily clinical practice and nutrition management has not been performed.
“Validation of their utility for daily clinical practice and nutrition management has not been performed, and therefore only expert opinion can be expressed.”
The paper relies on this without support.
There are no studies directly addressing the effect of duration of starvation on outcome in critically ill patients.
“There are no studies directly addressing the effect of duration of starvation on outcome in critically ill patients.”
The paper relies on this without support.
Weight and body mass index (BMI) do not accurately reflect malnutrition.
“Weight and body mass index (BMI) do not accurately reflect malnutrition.”
The paper relies on this without support.
Early phase of critical illness is associated with relevant endogenous energy production.
“Provision of excessive amounts of nutrients by any route should be avoided in the early phase of critical illness, which is associated with relevant endogenous energy production.”
The paper relies on this without support.
Recent randomized controlled trials do not demonstrate a clear advantage of EN over PN.
“However, recent randomized controlled trials (RCTs) do not demonstrate a clear advantage of EN over PN, and the observed benefit of EN in earlier studies may be due to the higher energy and amino acid/protein content provided by PN compared to EN.”
The paper relies on this without support.
Enhancing EN tolerance and reducing complications lacks a definitive strategy.
“Enhancing EN tolerance and reducing complications lacks a definitive strategy.”
The paper relies on this without support.
Early full feeding also increases the risk of refeeding.
“Early full feeding also increases the risk of refeeding (see No. 60).”
The paper relies on this without support.
Prospective studies (Nutrirea-3, Permit, EPANIC) comparing two levels of energy intake found a benefit associated with early provision of lower amounts.
“However, prospective studies (Nutrirea-3 Permit EPANIC) comparing two levels of energy intake found a benefit associated with early provision of lower amounts.”
The paper relies on this without support.
Numerous observational studies showed associations between high-dose protein delivery and improved outcomes (morbidity or mortality).
“Numerous observational studies showed associations between high-dose protein delivery and improved outcomes (morbidity or mortality).”
The paper relies on this without support.
Acute metabolic changes as well as prolonged energy and protein deficits play a major role in patient outcome.
“recognizing that acute metabolic changes as well as prolonged energy and protein deficits play a major role in patient outcome.”
The paper relies on this without support.
Many available studies address only one or at most some of the specific aspects of nutritional therapy.
“For now, a gap exists between nutritional practices and the previous guideline [7] and many available studies address only one or at most some of the specific aspects of nutritional therapy.”
The paper relies on this without support.
In critical illness, insulin resistance and hyperglycemia are common secondary to stress.
“Carbohydrates are the preferential substrate for production of energy, but in critical illness, insulin resistance and hyperglycemia are common secondary to stress.”
The paper relies on this without support.
Propofol is a source of fatty acids.
“Special attention should be paid if propofol is administered, since it is a source of FAs.”
The paper relies on this without support.
Predictive equations are inaccurate for guiding energy requirements.
“If hypocaloric medical nutrition therapy appears to be the rule on many ICUs [7], we recommend the measurement of energy expenditure with indirect calorimetry and urinary nitrogen loss to guide energy requirements and protein needs, since predictive equations are inaccurate.”
The paper relies on this without support.
Muscle mass typically is maximal between 25 and 35 years of age and decreases thereafter.
“Muscle mass typically is maximal between 25 and 35 years of age and decreases thereafter.”
The paper relies on this without support.
The proportion of muscle within the excess weight of an obese individual might be roughly 10%.
“The proportion of muscle within the excess weight of an obese individual might be roughly 10%.”
The paper relies on this without support.
The blood levels of several micronutrients are below normal ranges during the inflammatory response, and hence the impact of their provision is difficult to interpret.
“The blood levels of several micronutrients are below normal ranges during the inflammatory response, and hence the impact of their provision is difficult to interpret.”
The paper relies on this without support.
Vitamin D3 can be synthesized in sufficient amounts by the human body so long as there is exposure to sunlight and good liver and renal function.
“Vitamin D3 can be synthesized in sufficient amounts by the human body so long as there is exposure to sunlight and good liver and renal function.”
The paper relies on this without support.
This post-extubation swallowing disorder could be prolonged for to up to 21 days mainly in the elderly and after prolonged intubation.
“This post-extubation swallowing disorder could be prolonged for to up to 21 days mainly in the elderly and after prolonged intubation.”
The paper relies on this without support.
The measurement of GRV for the assessment of gastrointestinal dysfunction is common and may help to identify intolerance to EN during initiation and progression of EN.
“The measurement of GRV for the assessment of gastrointestinal dysfunction is common and may help to identify intolerance to EN during initiation and progression of EN.”
The paper relies on this without support.
Measurements of phosphate are less common than measurements of potassium in critically ill patients.
“Importantly, whereas potassium is commonly measured in critically ill patients, measurements of phosphate are less common.”
The paper relies on this without support.
Undetected rapid development of severe hypophosphatemia may lead to death after initiation of feeding.
“Undetected rapid development of severe hypophosphatemia may lead to death after initiation of feeding”
The paper relies on this without support.
Patients admitted to ICU are often malnourished either before or during admission to the hospital.
“as patients admitted to ICU are often malnourished either before or during admission to the hospital.”
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?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Therefore, it is recommended to initiate enteral feeding (EF) within 24–48 hours of intensive care unit (ICU) admission for critically ill patients [4,5].”
From The impact of enteral feeding intolerance on the prognosis of patients with septic shock in South Korea (2025) · cites this paper as [5]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The European Society for Clinical Nutrition and Metabolism135 recommends a more aggressive approach with early initiation of EN based on recent evidence139 compared with the more conservative approach of ASPEN.134”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [135]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“EN is more cost-effective; has lower rates of infection, overfeeding, and hyperglycemia compared with PN19,134,135”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [135]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“The European Society for Clinical Nutrition and Metabolism guidelines recommend delaying enteral nutrition in patients with overt bowel ischaemia and to implement PN within three to seven days. 181”
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Enteral nutrition is more cost-effective compared with parenteral nutrition and can decrease mortality and shorten lengths of stay.”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [135]
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated major: it would touch a result — a value a result rests on, reported and recomputed p-values on opposite sides of the significance level, two passages that conflict with no sign which is right, or a cited work retracted before this paper was published.
In the paper
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
“RR -0.47”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
“95%CI -7.57 to À1.71”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > Commentary
“Pradelli et al. [96] conducted a meta-analysis of 24 RCTs comparing fish oil-enriched PN with standard (non-fish oil-enriched) PN in adult patients in the ICU.”
§ ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit > References
“96. Wang H, Su S, Wang C, Hu J, Dan W, Peng X. Effects of fish oil-containing nutrition supplementation in adult sepsis patients: a systematic review and meta-analysis.”
Citations
Cites
Frailty in Older Adults: Evidence for a Phenotype
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., et al. (2001) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/56.3.m146 · Cited by 24,907
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
KONDRUP, J. (2003) · Clinical Nutrition · doi:10.1016/s0261-5614(02)00214-5 · Cited by 3,063
Cederholm, T., Jensen, G. L., Correia, M. I. T. D., Gonzalez, M. C., Fukushima, R., Higashiguchi, T., Baptista, G., Barazzoni, R., Blaauw, R., Coats, A., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.08.002 · Cited by 3,022
Self-citationESPEN guideline on clinical nutrition in the intensive care unit.
Singer, P., Blaser, A. R., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., Hiesmayr, M., Mayer, K., Montejo, J. C., Pichard, C., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.08.037 · Cited by 2,904 · cited 10×
“In comparing early EN with delayed EN (six studies in ICU patients and four studies including non-ICU patients), and similar to an earlier meta-analysis [13], a reduction of infectious complications with early EN (RR 0.76, CI 0.59, 0.97, p 0.03) was observed [4].”
BackgroundMethodResultInfluentialSelf-citationStudenski, S. A., Peters, K. W., Alley, D. E., Cawthon, P. M., McLean, R. R., Harris, T. B., Ferrucci, L., Guralnik, J. M., Fragala, M. S., Kenny, A. M., et al. (2014) · The Journals of Gerontology: Series A · doi:10.1093/gerona/glu010 · Cited by 2,545
ESPEN guidelines on parenteral nutrition: intensive care
Singer, P., Berger, M. M., Van den Berghe, G., Biolo, G., Calder, P., Forbes, A., Griffiths, R., Kreyman, G., Leverve, X., & Pichard, C. (2009) · Clinical Nutrition · doi:10.1016/j.clnu.2009.04.024 · Cited by 1,907
Self-citationDiagnostic criteria for malnutrition – An ESPEN Consensus Statement
Cederholm, T., Bosaeus, I., Barazzoni, R., Bauer, J., Van Gossum, A., Klek, S., Muscaritoli, M., Nyulasi, I., Ockenga, J., Schneider, S. M., et al. (2015) · Clinical Nutrition · doi:10.1016/j.clnu.2015.03.001 · Cited by 1,755
Self-citationCederholm, T., Jensen, G. L., Correia, M. I. T. D., Gonzalez, M. C., Fukushima, R., Higashiguchi, T., Baptista, G., Barazzoni, R., Blaauw, R., Coats, A. J. S., et al. (2019) · Journal of Cachexia, Sarcopenia and Muscle · doi:10.1002/jcsm.12383 · Cited by 1,724
Self-citationEarly versus late parenteral nutrition in critically ill adults
Casaer, M. P., Mesotten, D., Hermans, G., Wouters, P. J., Schetz, M., Meyfroidt, G., Van Cromphaut, S., Ingels, C., Meersseman, P., Muller, J., et al. (2011) · New England Journal of Medicine · doi:10.1056/nejmoa1102662 · Cited by 1,696 · cited 3×
“Casaer et al. [14] observed that early (supplemental or exclusive) PN is associated with increased morbidity including prolonged ICU dependency and mechanical ventilation, and increased infection rate and need for renal replacement therapy.”
BackgroundInfluentialSelf-citation
Cited by
Sorted by citations
Bels, J. L. M., Thiessen, S., van Gassel, R. J. J., Beishuizen, A., De Bie Dekker, A., Fraipont, V., Lamote, S., Ledoux, D., Scheeren, C., De Waele, E., et al. (2024) · The Lancet · doi:10.1016/s0140-6736(24)01304-7 · Cited by 174
Cederholm, T., & Bosaeus, I. (2024) · New England Journal of Medicine · doi:10.1056/nejmra2212159 · Cited by 131
Koelemay, M. J., Geelkerken, R. H., Kärkkäinen, J., Leone, N., Antoniou, G. A., de Bruin, J. L., Gombert, A., Gottsätter, A., Iborra, E., Ronchey, S., et al. (2025) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2025.06.010 · Cited by 123
Self-citationPaulus, M. C., Melchers, M., van Es, A., Kouw, I. W. K., & van Zanten, A. R. H. (2025) · Critical Care · doi:10.1186/s13054-025-05396-6 · Cited by 112
Post-intensive care syndrome follow-up system after hospital discharge: a narrative review
Nakanishi, N., Liu, K., Hatakeyama, J., Kawauchi, A., Yoshida, M., Sumita, H., Miyamoto, K., & Nakamura, K. (2024) · Journal of Intensive Care · doi:10.1186/s40560-023-00716-w · Cited by 113
Metadata
- Authors
- Singer, P., Blaser, A. R., Berger, M. M., Calder, P. C., Casaer, M., Hiesmayr, M., Mayer, K., Montejo-Gonzalez, J. C., Pichard, C., Preiser, J.-C., Szczeklik, W., van Zanten, A. R. H., & Bischoff, S. C.
- Affiliations
- Tel Aviv University (IL)
- Luzerner Kantonsspital (CH)
- Centre Hospitalier Universitaire Vaudois (CH)
- University Hospital Southampton NHS Foundation Trust (GB)
- Universitair Ziekenhuis Leuven (BE)
- Medical University of Vienna (AT)
- St. Vincentius-Kliniken (DE)
- University Hospital of Geneva (CH)
- Université Libre de Bruxelles (BE)
- Jagiellonian University (PL)
- University of Hohenheim (DE)
- Corresponding author
- Singer, Pierre
- ORCID
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2023-09
- Volume
- 42
- Issue
- 9
- Pages
- 1671-1689
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W4384297410
- Cited by
- 793
- References
- 150
- Citations by year
- 2026: 345 · 2025: 262 · 2024: 170 · 2023: 16
- FWCI
- 138.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Socio-Environmental Systems Modeling (submittedVersion)
- Jagiellonian University Repository (Jagiellonian University) (submittedVersion, cc-by-nc-nd)
- IRIS (submittedVersion)
- Lirias (KU Leuven) (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Funders
- McMaster University
- European Society for Clinical Nutrition and Metabolism
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- intensive care unit, critically ill patients, medical nutrition therapy, ESPEN guidelines, standard operating procedures, flowcharts
- MeSH terms
- Humans, Intensive Care Units, Nutritional Status, Parenteral Nutrition, 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.
A language model drew the claims from the paper on 2026-10-20, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-20 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
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 ›
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