"This study shows that there is no difference in the mortality at 30 days and as well at 90 days between both the early parenteral & enteral nutrition arm & no difference in mechanical ventilation days,incidence of infections .On the contrary,enteral group had more hypoglycemic events,vomiting & gastric intolerance needing more prokinetics.On the other hand, EPNIC Trial showed increased mechanical ventilation days,increased incidence of infections,low hypoglycemic rates in early parenteral group with no difference in 90 day mortality in either of the groups"
" Author attributes the reason for less complications with parenteral nutrition to better and advanced vascular techniques ,better VAP and CRBSI prevention protocols,Better and efficient parenteral nutrition deliver methods,monitoring on parenteral nutrition, which was not considered in the previous trials" .
kindly post your comments
ASPEN guidelines is contradicted by this study...aspen suggests parenteral only after 7 days unless malnourished
ReplyDeleteEPANIC study also supports late initiation of parenteral nutrition
EARLY PN study also against early parenteral...kindly refer this article
Early Parenteral Nutrition in Critically Ill Patients with Short term Relative Contraindications to Early Enteral Nutrition
- Early PN trial
JAMA. 2013;309(20):2130-2138
Early Parenteral Nutrition in Critically Ill Patients with Short term Relative Contraindications to Early Enteral Nutrition
- Early PN trial
Randomised control study
JAMA. 2013;309(20):2130-2138
Its been shown in meta analysis and systematic reviews of many RCT'S comparing early parenteral vs early enteral, that early parenteral nutrition less than 8 days is associated with complications(more mechanical ventilation days,more infectious complications,more ICU LOS) but no mortality benefit between either of the groups.
ReplyDelete" Author attributes the reason for less complications with parenteral nutrition to better and advanced vascular techniques ,better VAP and CRBSI prevention protocols,Better and efficient parenteral nutrition deliver methods,monitoring on parenteral nutrition, which was not considered in the previous trials" .
Post Hoc Analysis in EPANIC study showed that more infectious complications are associated with the dose of parenteral nutrition rather than solely on the route of nutrition.
ReplyDeleteMost of the previous trials are complicated by variable quality,selection bias and no standard definitions, multiple variables(Timing, route).current evidence for enteral nutrition is based on physiological rationale with modest and intermediate quality evidence
ReplyDelete