Parenteral with enteral nutrition in the critically ill

• Published in: Intensive care medicine Vol. 26; no. 7; pp. 893 - 900
• Main Authors: BAUER, P, CHARPENTIER, C, BOUCHET, C, NACE, L, RAFFY, F, GACONNET, N
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01.07.2000; Berlin Springer Nature B.V
• Subjects: Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Carbohydrates; Cardiovascular disease; Cost-Benefit Analysis; Double-Blind Method; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Energy Intake; Enteral nutrition; Enteral Nutrition - economics; Fatalities; Female; Hospital Mortality; Humans; Intensive care; Intensive care medicine; Intensive Care Units - economics; Length of Stay; Male; Malnutrition; Medical sciences; Middle Aged; Morbidity; Mortality; Multiple organ dysfunction syndrome; Nutrition; Parenteral nutrition; Parenteral Nutrition - economics; Parenteral Nutrition - methods; Patients; Prealbumin - metabolism; Prospective Studies; Proteins; Retinol-Binding Proteins - metabolism; Sepsis; France; Human; Intensive care; Prognosis; Critically ill; Mortality; Adjuvant treatment; Metabolism; Morbidity; Enteral administration; Parenteral administration; Feeding; Randomization; Thyroxine binding prealbumin; Double blind study; Comparative study
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s001340051278

To determine whether nutrient intake by early enteral nutrition with parenteral nutrition improves levels of retinol-binding protein and prealbumin (primary endpoint) and reduce morbidity and mortality (secondary endpoint) in ICU patients. Prospective, double-blind, and randomized, placebo-controlled study. Two intensive care units in a tertiary institution. 120 patients in two groups of 60. Patients received either enteral plus parenteral nutrition (treatment group) or enteral nutrition plus placebo (placebo group) for 4-7 days after initiation of nutritional support. Retinol-binding protein (P = 0.0496) and prealbumin (P = 0.0369) increased significantly in the treatment group from day 0 to day 7. There was no reduction in morbidity in ICU. There was no difference in OMEGA score (263 vs. 244) and length of stay in the ICU (16.9 vs. 17.3), but a reduction in length of stay at hospital (31.2+/-18.5 vs. 33.7+/-27.7, P = 0.0022). Mortality on day 90 (17 vs. 18) and after 2 years (24 vs. 24) was identical. Although it enhances nutrient intake and corrects nutritional parameters such as RBP and prealbumin more rapidly, within 1 week, supplemental parenteral nutrition has no clinically relevant effect on outcome in ICU patients at the early phase of nutritional support.