Effect of Early versus Delayed Parenteral Nutrition on the Health Outcomes of Critically Ill Adults: A Systematic Review

Sharma, Suresh K.; Rani, Raj; Thakur, Kalpana

doi:10.2478/jccm-2021-0011

Cited by 4 publications

(4 citation statements)

References 25 publications

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“…The findings from previous studies indicate that E-SPN was associated with shorter ICU stay and lower mortality than L-SPN. In parallel to the lower nosocomial infection rate in the E-SPN group, fewer therapeutic antibiotic days were observed in the E-SPN group than in the L-SPN group.…”

Section: Discussionmentioning

confidence: 89%

Effect of Early vs Late Supplemental Parenteral Nutrition in Patients Undergoing Abdominal Surgery

et al. 2022

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IMPORTANCEThe effect of and optimal timing for initiating supplemental parenteral nutrition (SPN) remain unclear after major abdominal surgery for patients in whom energy targets cannot be met by enteral nutrition (EN) alone.OBJECTIVE To examine the effect of early supplemental parenteral nutrition (E-SPN) (day 3 after surgery) or late supplemental parenteral nutrition (L-SPN) (day 8 after surgery) on the incidence of nosocomial infections in patients undergoing major abdominal surgery who are at high nutritional risk and have poor tolerance to EN. DESIGN, SETTING, AND PARTICIPANTSA multicenter randomized clinical trial was conducted from April 1, 2017, to December 31, 2018, in the general surgery department of 11 tertiary hospitals in China. Participants were those undergoing major abdominal surgery with high nutritional risk and poor tolerance to EN (Յ30% of energy targets from EN on postoperative day 2, calculated as 25 and 30 kcal/kg of ideal body weight daily for women and men, respectively) and an expected postoperative hospital stay longer than 7 days. Data analysis was performed from February 1 to October 31, 2020.INTERVENTIONS Random allocation to E-SPN (starting on day 3 after surgery) or L-SPN (starting on day 8 after surgery). MAIN OUTCOMES AND MEASURESThe primary outcome was the incidence of nosocomial infections between postoperative day 3 and hospital discharge.RESULTS A total of 230 patients (mean [SD] age, 60.1 [11.2] years; 140 men [61.1%]; all patients were of Han race and Asian ethnicity) were randomized (115 to the E-SPN group and 115 to the L-SPN group). One patient in the L-SPN group withdrew informed consent before the intervention. The E-SPN group received more mean (SD) energy delivery between days 3 and 7 compared with the L-SPN group (26.5 [7.4] vs 15.1 [4.8] kcal/kg daily; P < .001). The E-SPN group had significantly fewer nosocomial infections compared with the L-SPN group (10/115 [8.7%] vs 21/114 [18.4%]; risk difference, 9.7%; 95% CI, 0.9%-18.5%; P = .04). No significant differences were found between the E-SPN group and the L-SPN group in the mean (SD) number of noninfectious complications (31/115 [27.0%] vs 38/114 [33.3%]; risk difference, 6.4%; 95% CI, −5.5% to 18.2%; P = .32), total adverse events (75/115 [65.2%] vs 82/114 [71.9%]; risk difference, 6.7%; 95% CI, −5.3% to 18.7%; P = .32), and rates of other secondary outcomes. A significant difference was found in the mean (SD) number of therapeutic antibiotic days between the E-SPN group and the L-SPN group (6.0 [0.8] vs 7.0 [1.1] days; mean difference, 1.0 days; 95% CI, 0.2-1.9 days; P = .01). CONCLUSION AND RELEVANCEIn this randomized clinical trial, E-SPN was associated with reduced nosocomial infections in patients undergoing abdominal surgery and seems to be a favorable strategy for patients with high nutritional risk and poor tolerance to EN after major abdominal surgery.

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Section: Discussionmentioning

confidence: 89%

Effect of Early vs Late Supplemental Parenteral Nutrition in Patients Undergoing Abdominal Surgery

et al. 2022

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“…Recently, a systematic review and meta‐analysis (SRMA) highlighted that the combined use of EN and PN significantly increased nutrition intake, and was associated with a trend towards improved functional recovery in general patients in the ICU 52 . Nevertheless, due to heterogeneity of studies, the use of SPN remains debatable 40,53 …”

Section: Guidance On Timing and Route Of Mntmentioning

confidence: 99%

“…52 Nevertheless, due to heterogeneity of studies, the use of SPN remains debatable. 40,53 Specific PN concerns for patients receiving ECMO include the potential reaction between the ECMO circuit and the intravenous nutrients. Intravenous lipid emulsions may damage the ECMO circuit, such as breaking of stopcocks, fat emulsion agglutination, clogging of the membrane oxygenator with associated malfunction, and clot-formation within the circuit.…”

Section: The Role Of Pn In Patients Receiving Ecmomentioning

confidence: 99%

Medical nutrition therapy in patients receiving ECMO: Evidence‐based guidance for clinical practice

Dresen

Naidoo²,

Hill

et al. 2022

J Parenter Enteral Nutr

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Patients receiving extracorporeal membrane oxygenation (ECMO) inherit substantial disease‐associated metabolic, endocrinologic, and immunologic modifications. Along with the technical components of ECMO, the aforementioned alterations may affect patients' needs and feasibility of adequate macronutrient and micronutrient supply and intake. Thus, patients receiving ECMO are at increased risk for iatrogenic malnutrition and require targeted individual medical nutrition therapy (MNT). However, specific recommendations for MNT in patients receiving ECMO are limited and, with some exceptions, based on an evidence base encompassing general patients who are critically ill. Consequently, clinician decision‐making for MNT in patients receiving ECMO is unguided, which may further increase nutrition risk, culminating in iatrogenic malnutrition and ultimately affecting patient outcomes. The purpose of this article is to provide educational background and highlight specific points for MNT in adult patients receiving ECMO, which might serve as evidence‐based guidance to develop institutional standard operating procedures and nutrition protocols for daily clinical practice.

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“…Some studies support that PN, with close monitoring to avoid overfeeding and hyperglycemia, is beneficial ( 9 , 10 ). A systematic review showed that the supplemental PN patients had shorter ICU stay and lower mortality rates than those on total PN ( 11 ). Current international guidelines recommend the enteral route for ICU patients without contraindications to EN ( 3 , 12 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

Early parenteral nutrition comparing to enteral nutrition cannot reduce 28-day mortality in critically ill patients: a retrospective comparative cohort study based on the MIMIC-IV database

Bo¹,

Xi²,

Yu³

2023

Ann Transl Med

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Background Enteral nutrition (EN) is recommended as the first choice by guidelines for critical ill patients. But the timing of safe and effective delivery of parenteral nutrition (PN) is unclear and the results of previous studies are controversial. There is insufficient evidence for the use of early PN, so we designed this cohort study to compared the clinical outcomes of critical ill patients who received early PN with those who did not. Methods This retrospective study conducted using the Medical Information Mart for Intensive Care (MIMIC)-IV database. Patients who received nutrition therapy within 3 days of ICU admission were included and we categorized them as patients who received any kind of PN (PN group) or only enteral nutrition (EN group). Confounding factors were adjusted by propensity-score matching (PSM). The primary outcome was the 28-day mortality rate, and secondary outcomes included length of stay (LOS) in the hospital and ICU, hospital infection, and mechanical ventilation time. Results A total of 5,019 patients (PN group, 357; EN group, 4,662) were included in the analyses. The 28-day mortality rates showed no significant intergroup difference (EN, 22.3% vs . PN, 20.2%; P=0.378). The PN group showed a shorter median ICU LOS (EN, 8.14 vs . PN, 6.89 days, P=0.00955), and a longer median hospital LOS (PN, 21.55 vs . EN, 15.1 days, P<0.001). After PSM, each group included 355 patients, with no significant intergroup difference in the 28-day mortality rate (EN, 18.9% vs . PN, 20.3%; P=0.705). The PN group still showed a longer hospital LOS (median LOS: PN, 21.45 vs . EN, 14.81 days, P<0.001), but the other outcomes showed no differences. Conclusions PN within 3 days of ICU admission did not reduce the 28-day mortality rate and could extend hospital LOS. This study supports further fundamental and clinical research to ascertain the effect of PN for ICU patients.

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Effect of Early versus Delayed Parenteral Nutrition on the Health Outcomes of Critically Ill Adults: A Systematic Review

Cited by 4 publications

References 25 publications

Effect of Early vs Late Supplemental Parenteral Nutrition in Patients Undergoing Abdominal Surgery

Effect of Early vs Late Supplemental Parenteral Nutrition in Patients Undergoing Abdominal Surgery

Medical nutrition therapy in patients receiving ECMO: Evidence‐based guidance for clinical practice

Early parenteral nutrition comparing to enteral nutrition cannot reduce 28-day mortality in critically ill patients: a retrospective comparative cohort study based on the MIMIC-IV database

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