EPaNIC (original research)
Trial question
What is the role of late initiation of parenteral nutrition in critically ill patients to supplement insufficient enteral nutrition?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
36.0% female
64.0% male
N = 4640
4640 patients (1668 female, 2972 male)
Inclusion criteria: adult patients in the ICU who had a score of ≥ 3 on nutritional risk screening
Key exclusion criteria: age < 18 years, moribund, do-not-resuscitate code, short bowel syndrome, home ventilation, diabetic coma, pregnancy/lactation, receipt of oral nutrition, BMI < 17, nutritional risk screening score < 3
Interventions
N=2328 late parenteral initiation (parenteral nutrition not initiated before day 8)
N=2312 early parenteral initiation (parenteral nutrition initiated within 48 hours after ICU admission)
Primary outcome
Duration of stay in intensive care unit
3
4
4.0 days
3.0 days
2.0 days
1.0 days
0.0 days
Late parenteral
initiation
Early parenteral
initiation
Significant
increase ▲
Significant increase in duration of stay in the ICU (3 days vs. 4 days; HR 1.06, 95% CI 1 to 1.13)
Secondary outcomes
Significant decrease in new infection (22.8% vs. 26.2%; RR 0.87, 95% CI 0.23 to 1.51)
Significant increase in duration of hospital stay (14 days vs. 16 days; HR 1.06, 95% CI 1 to 1.13)
No significant difference in mechanical ventilation duration (2 days vs. 2 days; HR 1.06, 95% CI 0.99 to 1.12)
Safety outcomes
No significant differences in death in the ICU and hospital, nutrition-related complication.
Significant differences in discharged live from ICU within 8 days (75.2% vs. 71.7%), hypoglycemia during intervention (3.5% vs. 1.9%).
Conclusion
In adult patients in the ICU who had a score of ≥ 3 on nutritional risk screening, late parenteral initiation was superior to early parenteral initiation with respect to duration of stay in the ICU.
Reference
Michael P Casaer, Dieter Mesotten, Greet Hermans et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011 Aug 11;365(6):506-17.
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