Does early goal-directed nutrition (EGDN) reduce overall mortality in comparison to standard nutritional care in adult intensive care unit (ICU) patients? – An Update

Objective: To test whether selection bias has affected the reported effect estimate for EGDN in comparison to standard nutritional care (RD –0.03. 95%CI: -0.16 to 0.11), concerning overall mortality reduction in adult intensive care unit (ICU) patients. Method: Trial adjusted, simulated comparator trial (SCT) based I2 test for single randomised controlled trials, using revised I2 threshold limits. Result: A baseline covariate imbalance, either due to chance or due to selection bias was established, being equivalent to selection bias level = B% 0-30 (Bias category = 1). This level suggests that 0-30% of (0 – 60 of the total 199) subjects were non-randomly allocated in favour of one treatment group above the other. Conclusion: The effect estimate reported by the tested trial suggests a non-significant difference between the compared procedures in favor of EGDN for reducing the overall mortality rate. The selection bias level, estimated by use of the trial adjusted, simulated comparator trial (SCT) based I2 test for single RCTs, B% = 0-30%, appears to be not high enough in order to have affected the reported estimate. In line with new findings, this report updates previous report to the same RCT: EBSM Volume 2, Issue 2, 2026 Pages 31-34, DOI: 10.5281/zenodo.18456810.