Abstract
ObjectivesThis systematic review aims to evaluate and summarise the findings of all relevant studies which identified the effect of early vs delayed parenteral nutrition (PN), early PN vs early supplemental PN and early PN vs standard care for critically ill adults.MethodsThe literature search was undertaken using PubMed, Embase, Medline, Clinical Key, and Ovid discovery databases. The reference lists of studies published from 2000 till June 2020 were hand searched.ResultOn screening 2088 articles, a total of five RCTs with 6,277 patients were included in this review. Only one clinical trial compared early PN and late PN; the results reported significantly shorter periods in intensive care unit (ICU) stay (p=0.02) and less ICU related infections (p=0.008) in the late PN group compared to the Early PN group. Two trials compared total parenteral nutrition (TPN) and enteral nutrition (EN) +TPN groups. Both found a significantly longer hospital stay duration (p<0.05 and p<0.01) with a higher mortality rate in the TPN group compared to the EN+TPN group. A statistically significant improvement was observed in patients’ quality of life receiving early PN compared to standard care (p=0.01). In contrast, no significant difference was found in the supplemental PN vs the standard care group.ConclusionThe supplemental PN patients had shorter ICU stay and lower mortality rates than TPN. However, these findings should be interpreted carefully as included studies have different initiation timing of nutritional support, and the patients’ diagnosis varied.
Highlights
Nutritional support is considered an integral element in the treatment of seriously ill patients admitted to the intensive care unit (ICU)
This review aims to evaluate and summarise the findings of all relevant studies that identified the effect of early versus delayed parenteral nutrition, early PN versus early supplemental PN, and early parenteral nutrition versus standard care in critically ill adults
A comprehensive search strategy was developed based on keywords such as “early parenteral nutrition”, delayed parenteral nutrition” “supplemental parenteral nutrition”, “standard care”, “mortality rates”, “infection rates” “length of hospital and ICU stay”, “quality of life”, “metabolic and gastrointestinal complications”, “critically ill adults”
Summary
Nutritional support is considered an integral element in the treatment of seriously ill patients admitted to the ICU. Optimum nutrition levels are essential to maintain competent immune function, support anabolism, reduce the metabolic response to stress, decrease oxidative cell damage, and to improve critically ill patients’ health status [1]. Nutrients supplied for therapeutic reasons, whether orally, enterally, or parenterally are specified as specialised nutrition support (SNS). PN is used for patients who cannot be fed an appropriately oral diet or if the digestive tract is not functioning or inaccessible [2]. Enteral nutrition alone provides only 45% to 60% of energy due to difficulties with its provision rate. It has been recommended that energy provision be increased from 70% to 100% of estimated needs for three to seven days of ICU post-admission [4, 5]
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