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Table 3 Recent studies using parenteral nutrition.

From: Parenteral nutrition: never say never

  Early nutrition route Early PN SPN Hypocaloric vs. normocaloric Optimal protein-energy Protein nutrition
  [12] [9] [10] [32] [33] [34]
Study design Multicenter, pragmatic RT   Multicenter, RCT   Two center, RCT   Prospective RT   Single center, observational study    Single center, observational study   
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
  1. The recent PN studies are shown in the order of their citation in the article. Data are shown as stated in the original article
  2. APACHE Acute Physiology and Chronic Health Evaluation, BW body weight, EN enteral nutrition, PN parenteral nutrition, RCT randomized controlled trial, RT randomized trial, SOFA Sequential Organ Failure Assessment, SPN supplemental parenteral nutrition