For critically ill patients, early PN results in fewer days of ventilation, less muscle wasting
TUESDAY, May 21 (HealthDay News) -- For critically ill patients with relative contraindications to early enteral nutrition (EN), the provision of early parenteral nutrition (PN) is not associated with reductions in day-60 mortality, according to a study published online May 20 in the Journal of the American Medical Association to coincide with presentation at the annual meeting of the American Thoracic Society, held from May 17 to 22 in Philadelphia.
Gordon S. Doig, Ph.D., from the University of Sydney in Australia, and colleagues conducted a multicenter study involving 1,372 critically ill adults with relative contraindications to early EN. Participants were randomized to standard care (686 patients) or early PN (686 patients). Of those allocated to standard care, 29.2 percent initially started EN, 27.3 percent initially started PN, and 40.8 percent remained unfed.
The researchers found that the time to EN or PN was 2.8 days for patients in the standard-care group, while for patients receiving early PN, nutrition commenced 44 minutes after enrollment. There was no significant difference between the groups in day-60 mortality. For patients in the early PN group, day-60 quality of life was rated as statistically better, but the difference was not clinically meaningful. Patients who were allocated to early PN required significantly fewer days of invasive ventilation and experienced significantly less muscle wasting and fat loss.
"The provision of early PN to critically ill adults with relative contraindications to early EN, compared with standard care, did not result in a difference in day-60 mortality," the authors write.
Several authors disclosed financial ties to the pharmaceutical, nutrition, and health care industries, including Fresenius Kabi Deutschland and Baxter Healthcare, both of which partially funded the study and/or supplied the parenteral nutrition.
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