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ESPEN ASPENESPEN guidelines on

Parenteral Nutrition:

intensive care, Clinical

Nutrition 2009; 28: 387-400

Guidelines for the provision

and assessment of nutrition

support therapy in the adult

critically ill patient: SCCM and

ASPEN: Executive Summary. Crit

ESPEN ASPENNutrition 2009; 28: 387-400

ASPEN: Executive Summary. Crit

Care Med 2009; 37: 1757–61.

Canadian clinical practice guidelines for nutrition

support in mechanically ventilated, critically ill adult

patients. J Parenter Enteral Nutr 2003; 27: 355–73.

Introduction

• Mortality rate is higher with the use of:

- early PN alone

- early use of combined PN with EN

Does enteral nutrition compared to parenteral nutrition result

in better outcomes in critically ill adult patients?

A systematic review of the literature. Nutrition 2004; 20: 843–48.

Introduction

• Tight Calorie Control study (TICACOS)

- Lower hospital discharge mortality

- More infections

- Longer time on mechanical ventilation

The tight calorie control study (TICACOS): a prospective,

randomized, controlled pilot study of nutritional support

in critically ill patients. Intensive Care Med 2011;

37: 601–09.

Optimisation of energy

provision with

Supplemental Parenteral Nutrition

in critically ill patients:

A randomized controlled

clinical trial

R3 謝智凱

陳奇祥主任

clinical trial

Methods

• Switzerland

- Geneva University hospital.

- Lausanne University hospital.

• Mixed medical and surgical ICUs.

Trial Design

Women: 25kcal/kg EN: 20-30ml/h, up to

Man : 30kcal/kg maximum 150ml/h.

Exclusion Criteria

• Exclusion:

- Receiving PN

- Persistent GI dysfunction

- Ileus

- Pregnant

- Readmission

• Care providers and patients were not masked.

Trial Design

Trial Design

• EN formula: 1.05-1.62 kcal/ml.

• PN formula: 0.62-1.37 kcal/ml.

• Continuous IV insulin therapy: <8.5 mmol/L

Trial Endpoints

• Occurrence of nosocomial infections after day 8

until day 28.

- Pneumonia

- Bloodstream infection

- Urogenital infection- Urogenital infection

- Abdominal infection

- Others

Trial Endpoints

• Antibiotic days for nosocomial infection.

• Antibiotic free days.

• Duration of invasive and non-invasive

mechanical ventilation.

• Length of stay in ICU and hospital.• Length of stay in ICU and hospital.

Trial Profile

Dec, 2008

Dec, 2010

Demographic

Results

Mean energy delivery:

EN: 20kcal/kg

SPN: 28 kcal/kg

Mean cumulative energy balance

EN: 124 kcal

SPN: - 2317kcalSPN: - 2317kcal

Results

Nosocomial Infections

Results

41[27%] 58[38%] 41[27%] 58[38%]

Nosocomial infections

Secondary Outcomes

Secondary outcomes

• Hypoglycaemia

• Hyperglycaemia

• Renal replacement therapy

Secondary outcomes

• Alkaline Phosphatase concentrations lower in

SPN group (2.01 vs 2.75, p=0.0131).

• Decreased of CRP more in SPN group

(959.54 nmol/L vs 667.44 nmol/L, p=0.0180)

Discussion

• Delivery of near 100% of energy supply with an

SPN approach can effectively decrease infections

and antibiotic use.

Discussion

• Mortality rate is higher with the use of:

- early PN alone

- early use of combined PN with EN

Does enteral nutrition compared to parenteral nutrition result

in better outcomes in critically ill adult patients?

A systematic review of the literature. Nutrition 2004; 20: 843–48.

Discussion

• Tight Calorie Control study (TICACOS)

- Lower hospital discharge mortality

- More infections

- Longer time on mechanical ventilation

The tight calorie control study (TICACOS): a prospective,

randomized, controlled pilot study of nutritional support

in critically ill patients. Intensive Care Med 2011;

37: 601–09.