Early supplemental parenteral nutrition may reduce ventilation time and ICU stay in older underfed ICU patientsEarly nutrition support linked to shorter ICU stays for older patients on ventilators

Clinical nutrition ESPEN Published April 8, 2026 Study authors: Tang Feng, Guo Peng, Zhang Wei, Qin Huan, Xu Huan PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Consider early supplemental PN in older, underfed ICU patients, but note unreported safety and primary outcome.

This randomized controlled trial enrolled 92 ICU patients aged ≥60 years requiring mechanical ventilation who had achieved less than 50% of prescribed energy or protein targets from enteral nutrition by ICU day 3. Patients were assigned to receive early supplemental parenteral nutrition (E-SPN) initiated on ICU day 3 or late supplemental parenteral nutrition (L-SPN) initiated on ICU day 7.

Compared to the L-SPN group, the E-SPN group had significantly higher energy and protein intake until day 7, higher serum albumin and prealbumin levels by day 10, and higher diaphragm thickness and phosphate levels by day 10 (all P < 0.05). The E-SPN group also had a shorter mean duration of mechanical ventilation (157.8 ± 54.6 hours vs. 183.6 ± 61.0 hours; P = 0.035) and a shorter median ICU stay (240 hours vs. 288 hours; P = 0.015). Mortality was not affected, but absolute numbers were not reported.

Key limitations include the unreported primary outcome, lack of data on adverse events, tolerability, and follow-up duration. The study's funding and conflicts of interest were also not reported. For practice, this suggests a potential benefit of early supplemental parenteral nutrition in a specific, high-risk subgroup of older, underfed ICU patients, but the absence of safety data and the small sample size preclude definitive recommendations.

Researchers studied whether starting supplemental nutrition earlier could help older patients in intensive care who were on breathing machines. They looked at 92 patients aged 60 and older who were not getting enough nutrition through feeding tubes by their third day in the ICU. Half received extra nutrition through an IV starting on day 3, while the other half started on day 7.

The group that started the IV nutrition earlier had higher levels of certain proteins in their blood by day 10, which can indicate better nutrition status. They also spent less time on the ventilator (about 26 hours less on average) and had shorter ICU stays overall (about 48 hours less on average). There was no difference in mortality between the two groups.

This was a relatively small study, and the researchers did not report on safety concerns or side effects from the IV nutrition. They also did not follow patients after they left the hospital to see if there were any long-term benefits. While these early results are promising, doctors need larger studies that look at safety and long-term outcomes before changing how they manage nutrition for critically ill patients.

What this means for you:

Early IV nutrition was linked to better short-term outcomes in a small ICU study, but more research on safety is needed.

Study Details

Study typeRct

EvidenceLevel 2

Follow-up720.0 mo

PublishedApr 2026

PMID41565072

View Original Abstract ↓

BACKGROUND & AIMS: This study aimed to assess the effects of early supplemental parenteral nutrition (E-SPN) on clinical outcomes in older adults Intensive Care Unit (ICU) patients receiving mechanical ventilation who failed to meet their nutritional requirements through enteral feeding alone. METHODS: In this prospective randomized controlled trial (RCT), ICU patients aged ≥60 years who achieved <50 % of prescribed energy or protein targets from enteral nutrition (EN) by ICU day 3 were enrolled. EN was initiated within 24 h of ICU admission (prescribed energy target: up to 25 kcal/kg/day based on actual body weight (ABW); protein: 1.2-1.5 g/kg/day) and advanced progressively according to tolerance and metabolic monitoring. Eligible patients were randomized to either the E-SPN group (early supplemental parenteral nutrition, initiated on ICU day 3) or the L-SPN group (late supplemental parenteral nutrition, initiated on ICU day 7). RESULTS: Ninety-two patients completed the study (E-SPN: 45; L-SPN: 47). Baseline characteristics were comparable between groups. The E-SPN group achieved significantly higher energy and protein intake than the L-SPN group until day 7 (P < 0.05). By day 10, serum albumin and prealbumin levels and diaphragm thickness and phosphate levels were higher in the E-SPN group (P < 0.05). Early SPN significantly reduced the duration of mechanical ventilation (157.8 ± 54.6 vs. 183.6 ± 61.0 h, P = 0.035) and ICU stay (240 vs. 288 h, P = 0.015), without affecting mortality. CONCLUSION: In ICU patients aged ≥60 years at high nutritional risk requiring mechanical ventilation, initiating supplemental PN on ICU day 3 rather than day 7 improved energy and protein delivery, preserved diaphragm thickness, and shortened ventilation and ICU stay, without increasing mortality. These findings support a proactive, individualized nutrition strategy in older adults ICU patients with limited EN tolerance.

Early supplemental parenteral nutrition may reduce ventilation time and ICU stay in older underfed ICU patientsEarly nutrition support linked to shorter ICU stays for older patients on ventilators

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Early supplemental parenteral nutrition may reduce ventilation time and ICU stay in older underfed ICU patientsEarly nutrition support linked to shorter ICU stays for older patients on ventilators

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