Research
Mixed
Initiating supplemental parenteral nutrition (SPN) within the first week of ICU admission provides no clinically important benefit compared to enteral nutrition (EN) alone.
Do not start supplemental parenteral nutrition (SPN) in the first week of ICU stay for average critically ill patients. Focus on enteral nutrition (EN) tolerance. Consider SPN only after day 7 if EN remains insufficient, especially for malnourished patients.
GoodRefutesHIGH confidence
Based on findings of no clinically important benefit in providing SPN early in the ICU admission, we recommend not initiating SPN prior to day 7 of ICU admission.
Why this rating
High quality evidence based on RCTs, strong recommendation.
Source
Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition
Charlene Compher et al. · Journal of Parenteral and Enteral Nutrition · 2021
DOI 10.1002/jpen.2267
Meta-analysis · 36 studiesCited 641×
Read the paper DOI resolved against Crossref · corpus check 2026-06-10
More from this paper
- Providing similar energy intake via parenteral nutrition (PN) as compared to enteral nutrition (EN) in the first week of critical illness results in similar clinical outcomes.Good
- In adult critically ill patients, providing higher energy intake (up to 30 kcal/kg/day) compared to lower intake (down to 300 kcal/day) does not significantly improve clinical outcomes such as mortality, length of stay, or infection rates.Moderate
Related findings · Mixed
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- For patients with Class III obesity (BMI >39.9 kg/m2), metabolic bariatric surgery (MBS) is significantly more effective than any currently approved medication, with BilioPancreatic Diversion (BPD) showing the highest estimated weight loss.Strong
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