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© 2018 ASPEN | American Society for Parenteral and Enteral Nutrition. All Rights Reserved. A Modern Look at PN RECENT DATA

OLDER DATA • Randomized controlled trials in
larger cohorts
• Small sample sizes
• Higher calorie infusions • Optimized calorie administration
• Less stringent or unreported • Improvement in glycemic control
• ICU population
glycemic control • Standardized central line care and
• Well-nourished patients
• ICU vs non-ICU not reported ICU management
• No standardization of care

1. Kudsk KA. Enteral versus parenteral feeding: effects on septic morbidity after • Doig G. Early parenteral nutrition in critically ill patients with short-term relative

blunt and penetrating abdominal trauma. Ann Surg. 1992;215(5):503-513. contraindications to early enteral nutrition: a randomized controlled trial.
2. Moore FA.TEN versus TPN following major abdominal trauma—reduced septic
JAMA.2013;309(20):2130-2138.
morbidity. J Trauma. 1989;29(7):916-923. • Harvey SE. Trial of the route of early nutritional support in critically ill adults. N Engl J

Med. 2014;371(18):1673-1684.

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PN Outcomes – Current Evidence

Population Doig et al, 2013 1 Harvey et al, 20142 Heidegger et al, 20133
Intervention
ICU patients, multi-center, ICU patients, multicenter, ICU patients, 2 tertiary care
randomized, single-blinded randomized centers, randomized
N=1372 N=2388 N=305

PN within 24 hours or standard Randomized to EN or PN Randomized to EN with
care (SC) supplemental PN (SPN) or EN
© 2019 ASPEN | American Society for Parenteral and Enteral Nutrition. All Rights Reserved. alone
Kcals/Protein PN: ~1400 kcals/day, 0.7 g PN: 21.3 kcal/kg, 0.7 g
Outcomes protein/kg protein/kg SPN: 28 kcals/kg, 1.2 g
SC: ~500 kcal/day, 0.4 g EN: 18.5 kcals/kg, 0.6 g protein/kg
protein/kg protein/kg EN: 20 kcals/kg, 0.8 g
• 30 day mortality: no protein/kg
• 60 day mortality: no
difference difference • Nosocomial infections (day
• 90 day mortality : no 9-28): SPN 27% vs EN 38%,
• Improvement in RAND-36 P =.0338
measures, P=.01 difference
• Treated infections: no • Study not powered to detect
• Less muscle loss (P=.01), mortality difference
fat loss (P=.04) per SGA difference

• No difference in infectious 66
complications

1. Doig G. JAMA.2013;309(20):2130-2138.
2. Harvey SE. N Engl J Med. 2014;371(18):1673-1684.
3. Heidegger CP. Lancet. 2013;381:385-393

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