5/15/2023 0 Comments Espen mauno![]() Further, the critically ill patient is already in a catabolic crisis. This is important because starvation has deleterious effects, including immune and organ dysfunction. However, it is less certain when fasting becomes starvation. Failure to feed these patients eventually guarantees starvation and, if enough time lapses, death. Trial RegistrationĬritically ill patients are often unable to feed themselves, and frequently present in a fasting state. Late-initiation of PN was associated with faster recovery and fewer complications, when compared with early-initiation. 10 days (IQR 5-23) p = 0.008) and fewer patients requiring more than 2 days of mechanical ventilation (36.3% v. 26.2% p = 0.008), less days of renal replacement therapy (7 days (interquartile range 3-16) v. The late-initiation group, as compared to the early-initiation group, had fewer ICU infections (22.8% v. Rates of death in the ICU and survival at 90 days were similar between the two groups. The late-initiation group had a relative increase, of 6.3%, in the likelihood of being discharged earlier, and alive, from the ICU (hazard ratio 1.06 95% confidence interval 1.00-1,13 p = 0.04). The median stay in the ICU was one day shorter for the late-initiation group (3 v. Primary end point was the duration of dependency on intensive care, defined as the number of intensive care days and time to discharge from the ICU. It was restarted if enteral or oral feeding fell below 50% of calculated calorific needs. PN was continued until EN met 80% of calorific goals, or when oral nutrition was resumed. Both groups received early EN using a standardized protocol. InterventionĪfter enrollment, 2312 patients were randomized to receive PN 48 hours after ICU admission (early-initiation) and 2328 patients were randomized to receive PN on day 8 (late-initiation group). SubjectsĪll adults admitted to participating ICUs with a nutritional risk score of 3 or more who did not meet any exclusion criteria. Prospective, randomized, controlled, parallel-group, multicenter clinical trial. To compare early-initiation of PN (European guidelines) with late-initiation (American and Canadian guidelines) in adults who are receiving insufficient enteral nutrition in the intensive care unit (ICU). BackgroundĬontroversy exists about the timing of the initiation of parenteral nutrition (PN) in critically ill adults in whom caloric targets cannot be met by enteral nutrition (EN) alone. Early versus late parenteral nutrition in critically ill adults.
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