Table 3 Recent studies using parenteral nutrition.
| Â | Early nutrition route | Early PN | SPN | Hypocaloric vs. normocaloric | Optimal protein-energy | Protein nutrition | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Â | [12] | [9] | [10] | [32] | [33] | [34] | ||||||||
Study design | Multicenter, pragmatic RT | Â | Multicenter, RCT | Â | Two center, RCT | Â | Prospective RT | Â | Single center, observational study | Â | Â | Single center, observational study | Â | Â |
Study groups | Parenteral | Enteral | Standard care | Early PN | EN group | EN + SPN | Normocaloric | Hypocaloric | No target | Protein-energy | Energy only | Low protein (0.8 g/kg/day) | Medium protein (1.1 g/kg/day) | High protein (1.5 g/kg/day) |
Patients enrolled (n) | 1188 | 1195 | 682 | 681 | 152 | 153 | 54 | 46 | 412 | 245 | 205 | 37 | 38 | 38 |
Route of nutrition | PN | EN | EN and/or PN | PN (and EN) | EN | EN + SPN | EN + SPN | EN and/or PN | EN + SPN | |||||
APACHE II score | 19.6 ± 6.9 | 19.6 ± 7.0 | 21.5 ± 7.8 | 20.5 ± 7.4 | 23 ± 7 | 22 ± 7 | 27.7 ± 8.4 | 30.5 ± 8.5 | 23 ± 8 | 23.2 ± 7.4 | 21.9 ± 5.9 | 22.1 ± 6.8 | ||
Energy target | 25 kcal/kg BW/day | Not specified | Harris-Benedict equation | Indirect calorimetry, or 25 kcal/kg BW/day (females) and 30 kcal/kg BW/day (males) | Indirect calorimetry, 100% EE, or Ireton-Jones equation | Indirect calorimetry, 50% EE, or Ireton-Jones equation | Harris-Benedict equation with added 20% for stress and 10% for activity until indirect calorimetry; EE from indirect calorimetry + 10% for activity | EE from indirect calorimetry, 25-30 kcal/day before calorimetry | ||||||
Protein target | Not specified | Not specified | 1.2 g/kg ideal BW | Not specified | 1.2-1.5 g/kg preadmission body weight | 1.2-1.5 g/kg (classified according to actual provision) | ||||||||
Primary outcome | No significant difference in death within 30 days between parenteral (33.1%) and enteral (34.2%) groups | No significant difference in crude day-60 mortality (standard care (22.8%) vs. early PN (21.5%)) | Significantly reduced late nosocomial infections for EN + SPN (27%) vs. EN (38%) | Significantly higher rate of nosocomial infections for hypocaloric group (26.1%) vs. normocaloric group (11.1%) | 50% decrease in 28-day mortality for protein-energy target group compared with no target group | Lower ICU mortality for patients with medium (24%) and high (16%) protein provision compared with low (27%) protein provision | ||||||||
Secondary outcome | Lower rate of hypoglycemia in parenteral (3.7%) vs. enteral (6.2%); lower rate of vomiting in parenteral (8.4%) vs. enteral (16.2%) | Significantly shorter duration of mechanical ventilation; significantly shorter for early PN | No significant difference in the length of stay in the ICU, the length of stay in the hospital, or mortality | Insulin demand higher in the normocaloric group; no significant difference for blood glucose level, duration of mechanical ventilation, or mortality | No significant difference for meeting energy target alone | APACHE II score, SOFA score, age also predict outcome, amount of energy provision was not related to outcome | ||||||||