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Randomized Controlled Trial
. 2024 Oct;50(10):1593-1602.
doi: 10.1007/s00134-024-07546-w. Epub 2024 Jul 17.

Impact of withholding early parenteral nutrition on 2-year mortality and functional outcome in critically ill adults

Michael P Casaer #  1 , Hendrik Stragier #  2   3 , Greet Hermans  4 , Alexandra Hendrickx  2 , Pieter J Wouters  2 , Jasperina Dubois  2   5 , Fabian Guiza  2 , Greet Van den Berghe  2 , Jan Gunst  2
Affiliations
Randomized Controlled Trial

Impact of withholding early parenteral nutrition on 2-year mortality and functional outcome in critically ill adults

Michael P Casaer et al. Intensive Care Med. 2024 Oct.

Abstract

Purpose: In critically ill adults, withholding parenteral nutrition until 1 week after intensive care admission (Late-PN) facilitated recovery as compared with early supplementation of insufficient enteral nutrition with parenteral nutrition (Early-PN). However, the impact on long-term mortality and functional outcome, in relation to the estimated nutritional risk, remains unclear.

Methods: In this prospective follow-up study of the multicenter EPaNIC randomized controlled trial, we investigated the impact of Late-PN on 2-year mortality (N = 4640) and physical functioning, assessed by the 36-Item Short Form Health Survey (SF-36; in 3292 survivors, responding 819 [738-1058] days post-randomization). To account for missing data, we repeated the analyses in two imputed models. To identify potential heterogeneity of treatment effects, we investigated the impact of Late-PN in different nutritional risk subgroups as defined by Nutritional Risk Screening-2002-score, modified NUTrition Risk in the Critically Ill-score, and age (above/below 70 years), and we evaluated whether there was statistically significant interaction between classification to a nutritional risk subgroup and the effect of the randomized intervention. Secondary outcomes were SF-36-derived physical and mental component scores (PCS & MCS).

Results: Two-year mortality (20.5% in Late-PN, 19.8% in Early-PN; P = 0.54) and physical functioning (70 [40-90] in both study-arms; P = 0.99) were similar in both groups, also after imputation of missing physical functioning data. Likewise, Late-PN had no impact on 2-year mortality and physical functioning in any nutritional risk subgroup. PCS and MCS were similar in both groups.

Conclusion: Late-PN did not alter 2-year survival and physical functioning in adult critically ill patients, independent of anticipated nutritional risk.

Trial registration: ClinicalTrials.gov NCT00512122.

Keywords: Critical illness; Individualized medicine; Intensive care; Nutritional risk; Parenteral nutrition; Physical function.

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References

    1. Casaer MP et al (2011) Early versus late parenteral nutrition in critically ill adults. N Engl J Med 365(6):506–517 - PubMed - DOI
    1. Fivez T et al (2016) Early versus late parenteral nutrition in critically ill children. N Engl J Med 374(12):1111–1122 - PubMed - DOI
    1. Hermans G et al (2013) Effect of tolerating macronutrient deficit on the development of intensive-care unit acquired weakness: a subanalysis of the EPaNIC trial. Lancet Respir Med 1(8):621–629 - PubMed - DOI
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    1. Harvey SE et al (2014) Trial of the route of early nutritional support in critically ill adults. N Engl J Med 371(18):1673–1684 - PubMed - DOI

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