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	Since this article does not have an abstract, we have provided the first 149 words of the full text and any section headings.

To the Editor: Dr Doig and colleagues,¹ in their trial of evidence-based feeding guidelines, and Ms Jones and Dr Heyland,² in their accompanying Editorial, discussed nutrition therapy in critical care. Both sets of authors referred explicitly to the established important benefits of this intervention. The randomized controlled trial (RCT) successfully implemented guidelines that led to earlier feeding of more calories in ICUs. Success did not lead to any benefit in mortality or length of stay.

The authors proposed a variety of explanations for these findings but did not consider the possibility that earlier feeding of more calories does not improve mortality. Jones and Heyland referred to this possibility indirectly, however, in citing "large, rigorously designed RCTs currently under way and powered to detect differences in mortality." Large RCTs could not be done ethically unless the effectiveness of artificial feeding in this setting was still uncertain.

Financial Disclosures: None reported.

Thomas E. Finucane, MD
tfinucan@jhmi.edu
Division of Geriatric Medicine and Gerontology
Johns Hopkins Bayview Medical Center
Baltimore, Maryland

1. Doig GS, Simpson F, Finfer S; et al, Nutrition Guidelines Investigators of the ANZICS Clinical Trials Group. Effect of evidence-based feeding guidelines on mortality of critically ill adults: a cluster randomized controlled trial. JAMA. 2008;300(23):2731-2741. FREE FULL TEXT 2. Jones NE, Heyland DK. Implementing nutrition guidelines in the critical care setting: a worthwhile and achievable goal? JAMA. 2008;300(23):2798-2799. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2009;301(15):1543.

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Effect of Evidence-Based Feeding Guidelines on Mortality of Critically Ill Adults: A Cluster Randomized Controlled Trial
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