Mixed
In critically ill ICU patients, early parenteral nutrition (PN) combined with enteral nutrition delays recovery and increases infection risk compared to withholding PN for the first week (late PN), regardless of illness severity.
For critically ill patients in the ICU, current guidelines recommending early, full-calorie parenteral nutrition when enteral feeding is insufficient should be reconsidered. Evidence suggests that withholding parenteral nutrition for the first week (allowing a caloric deficit) leads to faster recovery, fewer infections, and shorter ICU stays, regardless of how sick the patient is. The focus should be on tolerating hypocaloric enteral feeding rather than aggressively reaching caloric targets via IV nutrition early on.
Early combined parenteral/enteral nutrition delayed recovery irrespective of severity of critical illness. No dose or type of macronutrient was found to be associated with improved outcome.
Why this rating
Based on a large, randomized controlled trial (n=4,640) with post-hoc subgroup analyses confirming robustness across severity levels.
Source
Role of Disease and Macronutrient Dose in the Randomized Controlled EPaNIC Trial
Michaël P. Casaer et al. · American Journal of Respiratory and Critical Care Medicine · 2012
DOI 10.1164/rccm.201206-0999oc
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