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Cited by 526Clinical Nutrition and GastroenterologyHyperglycemia and glycemic control in critically ill and hospitalized patientsEnhanced Recovery After Surgery

Early Parenteral Nutrition in Critically Ill Patients With Short-term Relative Contraindications to Early Enteral Nutrition: A Randomized Controlled Trial

Doig, Gordon S.·2013·JAMA
DOI 10.1001/jama.2013.5124
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Abstract

IMPORTANCE: Systematic reviews suggest adult patients in intensive care units (ICUs) with relative contraindications to early enteral nutrition (EN) may benefit from parenteral nutrition (PN) provided within 24 hours of ICU admission. OBJECTIVE: To determine whether providing early PN to critically ill adults with relative contraindications to early EN alters outcomes. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized, single-blind clinical trial conducted between October 2006 and June 2011 in ICUs of 31 community and tertiary hospitals in Australia and New Zealand. Participants were critically ill adults with relative contraindications to early EN who were expected to remain in the ICU longer than 2 days. INTERVENTIONS: Random allocation to pragmatic standard care or early PN. MAIN OUTCOMES AND MEASURES: Day-60 mortality; quality of life, infections, and body composition. RESULTS: A total of 1372 patients were randomized (686 to standard care, 686 to early PN). Of 682 patients receiving standard care, 199 patients (29.2%) initially commenced EN, 186 patients (27.3%) initially commenced PN, and 278 patients (40.8%) remained unfed. Time to EN or PN in patients receiving standard care was 2.8 days (95% CI, 2.3 to 3.4). Patients receiving early PN commenced PN a mean of 44 minutes after enrollment (95% CI, 36 to 55). Day-60 mortality did not differ significantly (22.8% for standard care vs 21.5% for early PN; risk difference, -1.26%; 95% CI, -6.6 to 4.1; P = .60). Early PN patients rated day-60 quality of life (RAND-36 General Health Status) statistically, but not clinically meaningfully, higher (45.5 for standard care vs 49.8 for early PN; mean difference, 4.3; 95% CI, 0.95 to 7.58; P = .01). Early PN patients required fewer days of invasive ventilation (7.73 vs 7.26 days per 10 patient × ICU days, risk difference, -0.47; 95% CI, -0.82 to -0.11; P = .01) and, based on Subjective Global Assessment, experienced less muscle wasting (0.43 vs 0.27 score increase per week; mean difference, -0.16; 95% CI, -0.28 to -0.038; P = .01) and fat loss (0.44 vs 0.31 score increase per week; mean difference, -0.13; 95% CI, -0.25 to -0.01; P = .04). CONCLUSIONS AND RELEVANCE: The provision of early PN to critically ill adults with relative contraindications to early EN, compared with standard care, did not result in a difference in day-60 mortality. The early PN strategy resulted in significantly fewer days of invasive ventilation but not significantly shorter ICU or hospital stays. TRIAL REGISTRATION: anzctr.org.au Identifier: ACTRN012605000704695.

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  • The primary outcomes of smaller studies comparing early PN with other modalities did not differ between groups.

    “The primary outcomes of the smaller studies comparing early PN with other modalities did not differ between groups (152, 153).”

    From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [153]

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Authors
Doig, G. S.
Affiliations
The University of Sydney (AU)
Corresponding author
Doig, Gordon S.
ORCID
Doig, Gordon S.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2013-05-22
Volume
309
Issue
20
Pages
2130
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2013.5124
OpenAlex
W2126479503
Cited by
526
References
1
Citations by year
2026: 11 · 2025: 23 · 2024: 23 · 2023: 29 · 2022: 21 · 2021: 30 · 2020: 47 · 2019: 26 · 2018: 44 · 2017: 50 · 2016: 58 · 2015: 82 · 2014: 65 · 2013: 17
FWCI
68.37
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
  • Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
Keywords
early parenteral nutrition, early enteral nutrition, critically ill adults, intensive care unit, quality of life, invasive mechanical ventilation, body composition, infection, nutritional support timing, ICU length of stay, body mass index
MeSH terms
Contraindications, Aged, Aged, 80 and over, Enteral Nutrition, Female, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Parenteral Nutrition, Patient Admission, Respiration, Artificial, Time Factors, Single-Blind Method, Critical Illness, Treatment Outcome

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