title: Early parenteral nutrition alone or accompanying enteral nutrition in critically ill patients: a systematic review and meta-analysis.
abstract: BACKGROUND
  Although several large-scale clinical trials shave examined the relationship between early parenteral nutrition (ePN) and critically ill patients, a consensus has not been reached. In addition, no meta-analysis in this area has yet been published. The objective of this meta-analysis was to examine the effect of ePN, alone or accompanying enteral nutrition, in critically ill patients.
  
  
  METHODS
  A meta-analysis was performed to evaluate risk ratios (RR) and mean differences with 95% confidence intervals (CIs) between the ePN and control groups. Subgroup analyses were conducted to evaluate combinations of early enteral nutrition (eEN).
  
  
  RESULTS
  Five randomized control trials (RCTs) were included. Compared with controls, ePN had no effect on mortality (RR: 1.05, 95% CI: 0.96, 1.16). Secondary outcomes were variable: compared with the control group, the ePN group required fewer days of ventilation (p=0.007, RR: -0.95, 95% CI: -1.64, -0.27), but a longer hospital stay (p<0.001, RR: 3.76, 95% CI: 2.25, 5.28).
  
  
  CONCLUSIONS
  Overall, this meta-analysis from RCTs indicates that provision of ePN within 24-48 hours has no benefit on the survival rate in critically ill patients. Thus, provision of ePN in patients is not needed in those who have contraindications to enteral nutrition or can tolerate a low volume of enteral nutrition.
authors.affiliation: Department of General Surgery, Jinling Hospital, School of Medical, Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Wan
authors.affiliation: Department of General Surgery, Jinling Hospital, School of Medical, Nanjing University, Nanjing, Jiangsu Province, China.|Clinical College of South Medical University, Guangdong Province, China.
authors.forename: Xuejin
authors.initials: X
authors.lastname: Gao
authors.affiliation: Department of General Surgery, Jinling Hospital, School of Medical, Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Tian
authors.affiliation: Department of General Surgery, Jinling Hospital, School of Medical, Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Wu
authors.affiliation: Department of General Surgery, Jinling Hospital, School of Medical, Nanjing University, Nanjing, Jiangsu Province, China. Email: wxinying@263.net.
authors.forename: Xinying
authors.initials: X
authors.lastname: Wang
mesh_terms: D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D010288:Parenteral Nutrition / Q000379:methods*; D013997:Time Factors