Nutrition in critical care · When to start parenteral nutrition
Early versus late parenteral nutrition in critically ill adults
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Late initiation of parenteral nutrition, after day 8 |
| Control | Early initiation within 48 hours |
| Population | 4640 critically ill adults |
| Follow-up | 90 days |
| Primary endpoint | Duration of ICU dependency |
| Result | Patients in the late-initiation group had a relative increase of 6.3% in the likelihood of earlier discharge alive from the ICU (hazard ratio 1.06, 95% CI 1.00 to 1.13), with fewer infections and complications and faster recovery. Late initiation also shortened renal-replacement therapy by a median of 3 days (p=0.008), reduced the proportion ventilated beyond 2 days by 9.7% (p=0.006), and cut health-care costs by a mean of EUR 1,110. |
| Secondary endpoints | Infection rate, duration of ventilation, renal replacement therapy, healthcare costs |
Late initiation of parenteral nutrition was associated with faster recovery and fewer complications, as compared with early initiation.
The trial authors, in the published abstract
Counter-intuitive and decisive: feeding critically ill patients aggressively early causes harm. It began a decade of trials — EDEN, PermiT, EFFORT Protein — all pointing the same way, that less nutrition early is better tolerated than more.
Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med 2011 Aug 11;365(6):506-17.