Early versus late parenteral nutrition in the adult ICU: feeding the patient or our conscience?

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Article appraised

Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med 2011; 365: 506-17.

Structured abstract

Background: Critical illness increases the risk of malnutrition, which can increase infections, prolong mechanical ventilation, delay recovery, and increase mortality. While enteral nutrition (EN) is considered optimal, this is not always an option. Furthermore, algorithms for parenteral nutrition (PN) vary significantly, and it is unclear whether early initiation or delay of parenteral feeding is preferable.

Objective: This study compares intensive care unit (ICU) duration of stay in adults randomized to early initiation of PN (within 48 hr of ICU admission) vs delayed (at eight days or later after ICU admission), as consistent with European and North American guidelines, respectively.

Design and setting: This multicentre parallel-group randomized controlled trial was carried out from August 2007 to November 2010 and