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Reconciling divergent results of the latest parenteral nutrition studies in the ICU.
MedLine Citation:
PMID:  23385424     Owner:  NLM     Status:  In-Data-Review    
PURPOSE OF REVIEW: Recent studies on the optimal modalities to feed patients during the ICU stay show divergent results. The level and the timing of energy provision is a critical issue, associated with the clinical outcome. These results questioned the clinical relevance of the recent guidelines issued by American, Canadian and European academic societies.
RECENT FINDINGS: Four recent prospective randomized studies enrolled critically ill patients who received various nutritional regimens and tested the effect of nutritional support on outcome. The Tight Calorie balance Control Study (TICACOS) targeted on calorie administration according to measured energy expenditure and found increased ICU morbidity but improved hospital mortality. The large EpaNIC study compared 'early' with 'late' (parenteral nutrition) nutrition, mostly in patients after cardiac surgery, and found an increased morbidity associated with early parenteral nutrition. The supplemental parenteral nutrition (SPN) study randomized the patients after 3 days and targeted the calories administered by parenteral nutrition as a complement to unsuccessful enteral nutrition using indirect calorimetry. The SPN resulted in less nosocomial infections and shorter duration of mechanical ventilation. Finally, a recent Australian study enrolled patients unable to be early fed enterally to receive, or not, parenteral nutrition targeted at 1500 kcal. No complications were noted in the parenteral nutrition group. Lessons from all these studies are summarized and should help in designing better studies and guidelines.
SUMMARY: The critical analysis of recent prospective studies comparing various levels of calorie administration, enteral versus parenteral nutrition and enteral versus SPN confirms the recommendations to avoid underfeeding and overfeeding. Parenteral nutrition, required if enteral feeding is failing, and if adjusted up to a measured optimal level, may improve outcome. More studies on the optimal level of energy and protein administration to optimize the clinical outcome are required to fine tune current guidelines.
Pierre Singer; Claude Pichard
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Current opinion in clinical nutrition and metabolic care     Volume:  16     ISSN:  1473-6519     ISO Abbreviation:  Curr Opin Clin Nutr Metab Care     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-06     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9804399     Medline TA:  Curr Opin Clin Nutr Metab Care     Country:  England    
Other Details:
Languages:  eng     Pagination:  187-93     Citation Subset:  IM    
aDepartment of General Intensive Care Medicine, Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel bDepartment of Nutrition, Geneva University Hospital, Geneva, Switzerland.
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