Does initial trophic nutrition reduce overall mortality in comparison to full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure? – An Update

Objective: To test whether selection bias has affected the reported effect estimate for initial trophic nutrition in comparison to full-energy enteral nutrition (RD 0.03. 95%CI: -0.08 to 0.14), concerning overall mortality in patients with acute respiratory failure. 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 200) 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-significantly higher overall mortality in the initial trophic nutrition intervention group. 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 39-42, DOI: 10.5281/zenodo.18457033.