title: Combined enteral and parenteral nutrition.
abstract: OBJECTIVE
  To review and discuss the evidence and arguments to combine enteral nutrition and parenteral nutrition in the ICU, in particular with reference to the Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients (EPaNIC) study.
  
  
  RESULTS
  The EPaNIC study shows an advantage in terms of discharges alive from the ICU when parenteral nutrition is delayed to day 8 as compared with combining enteral nutrition and parenteral nutrition from day 3 of ICU stay.
  
  
  CONCLUSIONS
  The difference between the guidelines from the European Society of Enteral and Parenteral Nutrition in Europe and American Society for Parenteral and Enteral Nutrition/Society of Critical Care Medicine in North America concerning the combination of enteral nutrition and parenteral nutrition during the initial week of ICU stay was reviewed. The EPaNIC study clearly demonstrates that early parenteral nutrition in the ICU is not in the best interests of most patients. Exactly at what time point the combination of enteral nutrition and parenteral nutrition should be considered is still an open question.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden. jan.wernerman@karolinska.se
authors.forename: Jan
authors.initials: J
authors.lastname: Wernerman
mesh_terms: D016638:Critical Illness / Q000628:therapy; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods*; D005060:Europe; D005069:Evaluation Studies as Topic; D017408:Guidelines as Topic; D006801:Humans; D007362:Intensive Care Units; D015201:Meta-Analysis as Topic; D009656:North America; D009752:Nutritional Status; D010288:Parenteral Nutrition / Q000379:methods*; D016896:Treatment Outcome