Title: Risk Factors for Enteral Feeding Intolerance in Critically Ill Patients: An Updated
Systematic Review and Meta-Analysis
Version: 0 Date: 14 Feb 2025
Reviewer's report:
With thanks, this is a good meta-analysis that addresses an important clinical question.
Addressing the points below would further strengthen the manuscript and enhance its impact:
1- EFI Definition: While the paper mentions the ESICM definition, it might be beneficial to
explicitly state the specific criteria used to define EFI in each of the included studies. Variations
in EFI definition across studies can be a source of heterogeneity and should be acknowledged
and discussed. A table summarizing the EFI definitions used in each study would be very helpful.
2- Heterogeneity: While heterogeneity is addressed, a deeper exploration of its sources
would strengthen the analysis. Subgroup analyses based on specific EFI definitions, patient
populations, or study designs could be insightful. Simply stating "clinical heterogeneity" is not
sufficient. What specific clinical factors might be contributing?
3- Missing Data: The paper mentions data extraction but doesn't explicitly state how missing
data was handled. Did the authors perform imputation? If so, what methods were used? This
should be clarified.
4- Specificity of Recommendations: The recommendations are somewhat general. For example,
"individualized EN implementation plan" is suggested, but no specific strategies are provided.
Providing more concrete examples of how the findings can be translated into practice would be
more helpful. For instance, what specific interventions should be considered for patients with
high APACHE II scores? What are the preferred methods for post-pyloric feeding?
5- Language/Typos: There are a few minor grammatical errors and typos throughout the
manuscript (e.g., "provised," "I2 of gender"). A thorough proofreading is recommended.
Search strategy:
1- Overly Broad Terms: Some of the terms used are very broad and likely to retrieve a large
number of irrelevant results. For example, "abdominal" and "gastrointestinal" are very general
and will appear in many articles not related to feeding intolerance. Similarly, "Feed*" will
capture "feeding," "feedings," "feeder," etc., which may not all be relevant.
2- MeSH Terms (PubMed Only): The use of MeSH terms is good for PubMed, but the strategy
needs to be adapted for other databases that use different subject heading systems (e.g., Embase's
Emtree terms). Simply translating MeSH terms directly to other databases is not effective.
Best regards
Title: Risk Factors for Enteral Feeding Intolerance in Critically Ill Patients: An Updated
Systematic Review and Meta-Analysis
Version: 0 Date: 14 Feb 2025
Reviewer's report:
With thanks, this is a good meta-analysis that addresses an important clinical question.
Addressing the points below would further strengthen the manuscript and enhance its impact:
1- EFI Definition: While the paper mentions the ESICM definition, it might be beneficial to
explicitly state the specific criteria used to define EFI in each of the included studies. Variations
in EFI definition across studies can be a source of heterogeneity and should be acknowledged
and discussed. A table summarizing the EFI definitions used in each study would be very helpful.
2- Heterogeneity: While heterogeneity is addressed, a deeper exploration of its sources
would strengthen the analysis. Subgroup analyses based on specific EFI definitions, patient
populations, or study designs could be insightful. Simply stating "clinical heterogeneity" is not
sufficient. What specific clinical factors might be contributing?
3- Missing Data: The paper mentions data extraction but doesn't explicitly state how missing
data was handled. Did the authors perform imputation? If so, what methods were used? This
should be clarified.
4- Specificity of Recommendations: The recommendations are somewhat general. For example,
"individualized EN implementation plan" is suggested, but no specific strategies are provided.
Providing more concrete examples of how the findings can be translated into practice would be
more helpful. For instance, what specific interventions should be considered for patients with
high APACHE II scores? What are the preferred methods for post-pyloric feeding?
5- Language/Typos: There are a few minor grammatical errors and typos throughout the
manuscript (e.g., "provised," "I2 of gender"). A thorough proofreading is recommended.
Search strategy:
1- Overly Broad Terms: Some of the terms used are very broad and likely to retrieve a large
number of irrelevant results. For example, "abdominal" and "gastrointestinal" are very general
and will appear in many articles not related to feeding intolerance. Similarly, "Feed*" will
capture "feeding," "feedings," "feeder," etc., which may not all be relevant.
2- MeSH Terms (PubMed Only): The use of MeSH terms is good for PubMed, but the strategy
needs to be adapted for other databases that use different subject heading systems (e.g., Embase's
Emtree terms). Simply translating MeSH terms directly to other databases is not effective.
Best regards
Please review this paper.
user
Title: Risk Factors for Enteral Feeding Intolerance in Critically Ill Patients: An Updated
Systematic Review and Meta-Analysis
Version: 0 Date: 14 Feb 2025
Reviewer's report:
With thanks, this is a good meta-analysis that addresses an important clinical question.
Addressing the points below would further strengthen the manuscript and enhance its impact:
1- EFI Definition: While the paper mentions the ESICM definition, it might be beneficial to
explicitly state the specific criteria used to define EFI in each of the included studies. Variations
in EFI definition across studies can be a source of heterogeneity and should be acknowledged
and discussed. A table summarizing the EFI definitions used in each study would be very helpful.
2- Heterogeneity: While heterogeneity is addressed, a deeper exploration of its sources
would strengthen the analysis. Subgroup analyses based on specific EFI definitions, patient
populations, or study designs could be insightful. Simply stating "clinical heterogeneity" is not
sufficient. What specific clinical factors might be contributing?
3- Missing Data: The paper mentions data extraction but doesn't explicitly state how missing
data was handled. Did the authors perform imputation? If so, what methods were used? This
should be clarified.
4- Specificity of Recommendations: The recommendations are somewhat general. For example,
"individualized EN implementation plan" is suggested, but no specific strategies are provided.
Providing more concrete examples of how the findings can be translated into practice would be
more helpful. For instance, what specific interventions should be considered for patients with
high APACHE II scores? What are the preferred methods for post-pyloric feeding?
5- Language/Typos: There are a few minor grammatical errors and typos throughout the
manuscript (e.g., "provised," "I2 of gender"). A thorough proofreading is recommended.
Search strategy:
1- Overly Broad Terms: Some of the terms used are very broad and likely to retrieve a large
number of irrelevant results. For example, "abdominal" and "gastrointestinal" are very general
and will appear in many articles not related to feeding intolerance. Similarly, "Feed*" will
capture "feeding," "feedings," "feeder," etc., which may not all be relevant.
2- MeSH Terms (PubMed Only): The use of MeSH terms is good for PubMed, but the strategy
needs to be adapted for other databases that use different subject heading systems (e.g., Embase's
Emtree terms). Simply translating MeSH terms directly to other databases is not effective.
Best regards
assistant