Parenteral with enteral nutrition in the critically ill.
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.


METHODS
Prospective, double-blind, and randomized, placebo-controlled study.


METHODS
Two intensive care units in a tertiary institution.


METHODS
120 patients in two groups of 60.


METHODS
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.


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.
Bauer
P
P
Réanimation Médicale, Hôpital Central, Nancy, France. pbauer@lsumc.edu
Charpentier
C
C
Bouchet
C
C
Nace
L
L
Raffy
F
F
Gaconnet
N
N
D000704:Analysis of Variance; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D002149:Energy Intake; D004750:Enteral Nutrition / Q000191:economics; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000191:economics / Q000379:methods*; D011228:Prealbumin / Q000378:metabolism; D011446:Prospective Studies; D012177:Retinol-Binding Proteins / Q000378:metabolism
D011228:Prealbumin; D012177:Retinol-Binding Proteins