Optimal delivery of enteral protein in the critically ill: A protocol for a systematic review and meta-analysis of randomised controlled trials
Bibliographic record
Abstract
BACKGROUND: The optimal dose of enteral protein to deliver during critical illness remains uncertain. International clinical practice guidelines recommend protein targets ranging from 1.2 to 2.0 g/kg body weight/day, which is greater than the amount recommended in health. This protocol details the conduct of a systematic review and meta-analysis to evaluate the effect of enteral protein delivered within the international recommended guidelines (1.2-2.0 g/kg/day) compared to less than international recommended guidelines (<1.2 g/kg/day) on mortality and morbidity outcomes. METHODS: A systematic review and meta-analysis will be undertaken in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement. A comprehensive literature search of studies indexed in MEDLINE, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials will be conducted. Studies will be included if they are randomised controlled trials (RCTs) enrolling adult critically ill patients comparing predominately enteral protein delivery with one arm receiving 1.2-2.0 g/kg/day protein/kg/day ('greater protein') and another arm receiving <1.2 g protein/kg/day ('lesser protein'). Two independent reviewers will perform title and full text screening for study inclusion, extract data from included studies, and assess study quality using the Cochrane Risk of Bias 2 tool. The primary outcome will be mortality at 90 days. Secondary outcomes will be clinical (infectious complications, and durations of ICU and hospital stays and mechanical ventilation), patient-centred (discharge destination, physical function and quality of life) and muscle (muscle mass, strength) outcomes. RESULTS: Random-effects meta-analysis will be fitted for all outcomes, and, for the primary outcome, risk ratios will be pooled using a random-effects meta-analysis model and pooled treatment effect presented as risk ratio (95% Confidence Interval). CONCLUSIONS: This systematic review and meta-analysis will compile data to determine whether outcomes are optimised with greater or lesser amounts of enteral protein delivered during critical illness. SYSTEMATIC REVIEW REGISTRATION: CRD42025547923.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.024 | 0.087 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.041 | 0.020 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".