Evidence mapPaperPMID 38771368Full record

ReviewIntensive care medicine2024

Nutrition in the intensive care unit: from the acute phase to beyond.

Angelique M E de Man, Jan Gunst, Annika Reintam Blaser

Abstract readReview
In one paragraph

Review in Intensive care medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 49 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
49citing papers in PubMed, 3 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

49 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Trial
  5. Article
  6. Review
  7. Timing-specific neutrality in a rigorous ICU anabolic trial.JPEN. Journal of parenteral and enteral nutrition · 2026
    Article
  8. Article
  9. Reply to: Timing-specific neutrality in a Rigorous ICU anabolic trial.JPEN. Journal of parenteral and enteral nutrition · 2026
    Article
  10. Observational
  11. Article
  12. Diabetes Management Strategies in Intensive Care Settings.The Medical clinics of North America · 2026
    Review
  13. Review
  14. Article
  15. Article
  16. Review
  17. Core outcome sets and trials of nutrition and metabolism interventions.Current opinion in clinical nutrition and metabolic care · 2026
    Review
  18. Article
  19. Review
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Angelique M E de Man *Department of Intensive Care, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, The Netherlands. ame.deman@amsterdamumc.nl.ORCID 0000-0001-8738-8295
Jan GunstLaboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.ORCID 0000-0003-2470-6393
Annika Reintam Blaser *Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.ORCID 0000-0003-1211-7372

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Recent randomized controlled trials (RCTs) have shown no benefit but  dose-dependent harm by early full nutritional support in critically ill patients. Lack of benefit may be explained by anabolic resistance, suppression of cellular repair processes, and aggravation of hyperglycemia and insulin needs. Also early high amino acid doses did not provide benefit, but instead associated with harm in patients with organ dysfunctions. However, most studies focused on nutritional interventions initiated during the first days after intensive care unit admission. Although the intervention window of some RCTs extended into the post-acute phase of critical illness, no large RCTs studied nutritional interventions initiated beyond the first week. Hence, clear evidence-based guidance on when and how to initiate and advance nutrition is lacking. Prolonged underfeeding will come at a price as there is no validated metabolic monitor that indicates readiness for medical nutrition therapy, and an adequate response to nutrition, which likely varies between patients. Also micronutrient status cannot be assessed reliably, as inflammation can cause redistribution, so that plasma micronutrient concentrations are not necessarily reflective of total body stores. Moreover, high doses of individual micronutrients have not proven beneficial. Accordingly, current evidence provides clear guidance on which nutritional strategies to avoid, but the ideal nutritional regimen for individual patients remains unclear. In this narrative review, we summarize the findings of recent studies, discuss possible mechanisms explaining the results, point out pitfalls in interpretation of RCTs and their effect on clinical practice, and formulate suggestions for future research.

Indexed as

Critical IllnessIntensive Care UnitsNutritional SupportCritical CareHumansMicronutrientsNutritional StatusRandomized Controlled Trials as TopicMicronutrientsAmino acidCritical illnessGlucoseIntensive careMacronutrientsMicronutrientsNutrition

Identifiers

PMID38771368
PMCPMC11245425

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.