RCT

EPaNIC

Early versus Late Parenteral Nutrition in Critically Ill Adults

NEJM, 2011 · Multicenter randomized controlled trial in 2 Belgian tertiary hospitals (n=4640)

Clinical question

Does early initiation of parenteral nutrition to supplement enteral nutrition improve recovery compared with withholding parenteral nutrition until day 8?

Population: Critically ill adults at nutritional risk admitted to medical and surgical ICUs
Intervention: Early parenteral nutrition (initiated within 48 hours to meet full caloric goals)
Comparator: Late parenteral nutrition (withheld until day 8; only 5% dextrose infusion given early)
Primary outcome: Time to discharge from the ICU and new infection rates
Result: Late PN was associated with an 6.3% faster rate of live ICU discharge (hazard ratio 1.06, P=0.02) and a significant reduction in ICU infections (22.8% vs 26.2%, P=0.008). Patients in the late-PN group had fewer days on mechanical ventilation (P=0.006) and shorter renal replacement therapy duration.

What the trial found

Withholding supplemental parenteral nutrition during the first week of critical illness accelerates recovery and reduces infectious complications.

Current guideline position

Strong recommendation in ESPEN and ASPEN nutrition guidelines.

Clinical interpretation

Overturned early aggressive parenteral feeding dogma; confirmed parenteral nutrition should be delayed until after day 7 in patients tolerating minimal enteral nutrition.

Clinical Context & Relevant Topics (1)

Disease Reference

Critical Illness Nutrition & Metabolism

Phased energy and protein delivery, early enteral nutrition when safe, indirect calorimetry, refeeding prevention, feeding-intolerance troubleshooting, and individualized parenteral nutrition timing.

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