Nutrition in critical care · Route of nutrition
Trial of the route of early nutritional support in critically ill adults
| Design | Multicentre pragmatic randomised controlled trial |
|---|---|
| Treatment | Early parenteral nutrition |
| Control | Early enteral nutrition |
| Population | 2388 analysed critically ill adults: 1191 parenteral and 1197 enteral |
| Follow-up | 90 days |
| Primary endpoint | All-cause mortality at 30 days |
| Result | By 30 days, 393 of 1188 patients (33.1%) in the parenteral group had died, with no significant difference from the enteral group. Treated infectious complications did not differ between the parenteral and enteral groups (mean 0.22 versus 0.21 per patient). |
| Secondary endpoints | Infectious complications, hypoglycaemia, vomiting, organ support |
We found no significant difference in 30-day mortality associated with the route of delivery of early nutritional support in critically ill adults.
The trial authors, in the published abstract
Dismantled the belief that the parenteral route is intrinsically dangerous. Enteral feeding remains first choice for practical reasons, but the trial removes the moral weight that used to attach to the decision.
Harvey SE, Parrott F, Harrison DA, et al. Trial of the route of early nutritional support in critically ill adults. N Engl J Med 2014 Oct 30;371(18):1673-84.