Parenteral with enteral nutrition in the critically ill

Byline: P. Bauer (1), C. Charpentier (1), C. Bouchet (1), L. Nace (1), F. Raffy (1), N. Gaconnet (1) Keywords: Key words Parenteral nutrition; Enteral nutrition; Nutritional assessment; Clinical trial; Randomized controlled trial; Intensive care Abstract: Objective: 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. Design: Prospective, double-blind, and randomized, placebo-controlled study. Setting: Two intensive care units in a tertiary institution. Patients and participants: 120 patients in two groups of 60.APInterventions: 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. Measurements and results: 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. Conclusions: 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. Author Affiliation: (1) Reanimation Medicale, Hopital Central, 54 035 Nancy, France, FR Article note: Received: 23 August 1999/Final revision received: 27 January 2000/Accepted: 25 February 2000