Early versus late parenteral nutrition in critically ill adults

January 01, 0001

Early versus late parenteral nutrition in critically ill adults

In this randomized, multicenter trial, the Belgian investigators compared early initiation of parenteral nutrition (European guidelines) with late initiation (American and Canadian guidelines) in adults in the intensive care unit (ICU) to supplement insufficient enteral nutrition. In 2312 patients, parenteral nutrition was initiated within 48 hours after ICU admission (early-initiation group), whereas in 2328 patients, parenteral nutrition was not initiated before day 8 (late-initiation group). A protocol for the early initiation of enteral nutrition was applied to both groups, and insulin was infused to achieve normoglycemia.

They found: "Patients in the late-initiation group had a relative increase of 6.3% in the likelihood of being discharged alive earlier from the ICU (hazard ratio, 1.06) and from the hospital (hazard ratio, 1.06), without evidence of decreased functional status at hospital discharge. Rates of death in the ICU and in the hospital and rates of survival at 90 days were similar in the two groups. Patients in the late-initiation group, as compared with the early-initiation group, had fewer ICU infections (22.8% vs. 26.2%) and a lower incidence of cholestasis. The late-initiation group had a relative reduction of 9.7% in the proportion of patients requiring more than 2 days of mechanical ventilation, a median reduction of 3 days in the duration of renal-replacement therapy, and a mean reduction in health care costs of €1,110 (about $1,600)."

The authors concluded: "Late initiation of parenteral nutrition was associated with faster recovery and fewer complications, as compared with early initiation."

Quality of care is improved at lower cost by initiating parenteral nutrition at about 8 days in critically ill adults.

For the full abstract, click here.

N Engl J Med 365:506-517, 11 August 2011 © 2011 to the Massachusetts Medical Society
Early versus Late Parenteral Nutrition in Critically Ill Adults. Michael P. Casaer, Dieter Mesotten, Greet Hermans, et al. Correspondence to Dr. Greet Van den Burghe: [email protected]

Category: T. Endocrine/Metabolic/Nutritional. Keywords: critical care, adults, parenteral nutrition, infection, mechanical ventilation, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 23 August 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.