Early supplemental parenteral nutrition may reduce ventilation time and ICU stay in older underfed ICU patients
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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.
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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.
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