Supplemental parenteral nutrition versus usual care in critically ill adults

A pilot randomized controlled study

Emma J. Ridley, Andrew R. Davies, Rachael Parke, Michael Bailey, Colin McArthur, Lyn Gillanders, D. James Cooper, Shay McGuinness, and for the Supplemental Parenteral Nutrition Clinical Investigators

Research output: Contribution to journalArticleResearchpeer-review

3 Citations (Scopus)

Abstract

Background: In the critically ill, energy delivery from enteral nutrition (EN) is often less than the estimated energy requirement. Parenteral nutrition (PN) as a supplement to EN may increase energy delivery. We aimed to determine if an individually titrated supplemental PN strategy commenced 48-72 hours following ICU admission and continued for up to 7 days would increase energy delivery to critically ill adults compared to usual care EN delivery. Methods: This study was a prospective, parallel group, phase II pilot trial conducted in six intensive care units in Australia and New Zealand. Mechanically ventilated adults with at least one organ failure and EN delivery below 80% of estimated energy requirement in the previous 24 hours received either a supplemental PN strategy (intervention group) or usual care EN delivery. EN in the usual care group could be supplemented with PN if EN remained insufficient after usual methods to optimise delivery were attempted. Results: There were 100 patients included in the study and 99 analysed. Overall, 71% of the study population were male, with a mean (SD) age of 59 (17) years, Acute Physiology and Chronic Health Evaluation II score of 18.2 (6.7) and body mass index of 29.6 (5.8) kg/m2. Significantly greater energy (mean (SD) 1712 (511) calories vs. 1130 (601) calories, p < 0.0001) and proportion of estimated energy requirement (mean (SD) 83 (25) % vs. 53 (29) %, p < 0.0001) from EN and/or PN was delivered to the intervention group compared to usual care. Delivery of protein and proportion of estimated protein requirements were also greater in the intervention group (mean (SD) 86 (25) g, 86 (23) %) compared to usual care (mean (SD) 53 (29) g, 51 (25) %, p < 0.0001). Antibiotic use, ICU and hospital length of stay, mortality and functional outcomes were similar between the two groups. Conclusions: This individually titrated supplemental PN strategy applied over 7 days significantly increased energy delivery when compared to usual care delivery. Clinical and functional outcomes were similar between the two patient groups.

Original languageEnglish
Article number12
Number of pages11
JournalCritical Care
Volume22
Issue number1
DOIs
Publication statusPublished - 23 Jan 2018

Keywords

  • Clinical nutrition
  • Critical care
  • Enteral nutrition
  • Intensive care
  • Nutrition therapy
  • Parenteral nutrition
  • Randomized controlled trial

Cite this

@article{1a8593166a8f452b9938d175937a53ea,
title = "Supplemental parenteral nutrition versus usual care in critically ill adults: A pilot randomized controlled study",
abstract = "Background: In the critically ill, energy delivery from enteral nutrition (EN) is often less than the estimated energy requirement. Parenteral nutrition (PN) as a supplement to EN may increase energy delivery. We aimed to determine if an individually titrated supplemental PN strategy commenced 48-72 hours following ICU admission and continued for up to 7 days would increase energy delivery to critically ill adults compared to usual care EN delivery. Methods: This study was a prospective, parallel group, phase II pilot trial conducted in six intensive care units in Australia and New Zealand. Mechanically ventilated adults with at least one organ failure and EN delivery below 80{\%} of estimated energy requirement in the previous 24 hours received either a supplemental PN strategy (intervention group) or usual care EN delivery. EN in the usual care group could be supplemented with PN if EN remained insufficient after usual methods to optimise delivery were attempted. Results: There were 100 patients included in the study and 99 analysed. Overall, 71{\%} of the study population were male, with a mean (SD) age of 59 (17) years, Acute Physiology and Chronic Health Evaluation II score of 18.2 (6.7) and body mass index of 29.6 (5.8) kg/m2. Significantly greater energy (mean (SD) 1712 (511) calories vs. 1130 (601) calories, p < 0.0001) and proportion of estimated energy requirement (mean (SD) 83 (25) {\%} vs. 53 (29) {\%}, p < 0.0001) from EN and/or PN was delivered to the intervention group compared to usual care. Delivery of protein and proportion of estimated protein requirements were also greater in the intervention group (mean (SD) 86 (25) g, 86 (23) {\%}) compared to usual care (mean (SD) 53 (29) g, 51 (25) {\%}, p < 0.0001). Antibiotic use, ICU and hospital length of stay, mortality and functional outcomes were similar between the two groups. Conclusions: This individually titrated supplemental PN strategy applied over 7 days significantly increased energy delivery when compared to usual care delivery. Clinical and functional outcomes were similar between the two patient groups.",
keywords = "Clinical nutrition, Critical care, Enteral nutrition, Intensive care, Nutrition therapy, Parenteral nutrition, Randomized controlled trial",
author = "Ridley, {Emma J.} and Davies, {Andrew R.} and Rachael Parke and Michael Bailey and Colin McArthur and Lyn Gillanders and Cooper, {D. James} and Shay McGuinness and {and for the Supplemental Parenteral Nutrition Clinical Investigators}",
year = "2018",
month = "1",
day = "23",
doi = "10.1186/s13054-018-1939-7",
language = "English",
volume = "22",
journal = "Critical Care",
issn = "1364-8535",
number = "1",

}

Supplemental parenteral nutrition versus usual care in critically ill adults : A pilot randomized controlled study. / Ridley, Emma J.; Davies, Andrew R.; Parke, Rachael; Bailey, Michael; McArthur, Colin; Gillanders, Lyn; Cooper, D. James; McGuinness, Shay; and for the Supplemental Parenteral Nutrition Clinical Investigators.

In: Critical Care, Vol. 22, No. 1, 12, 23.01.2018.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Supplemental parenteral nutrition versus usual care in critically ill adults

T2 - A pilot randomized controlled study

AU - Ridley, Emma J.

AU - Davies, Andrew R.

AU - Parke, Rachael

AU - Bailey, Michael

AU - McArthur, Colin

AU - Gillanders, Lyn

AU - Cooper, D. James

AU - McGuinness, Shay

AU - and for the Supplemental Parenteral Nutrition Clinical Investigators

PY - 2018/1/23

Y1 - 2018/1/23

N2 - Background: In the critically ill, energy delivery from enteral nutrition (EN) is often less than the estimated energy requirement. Parenteral nutrition (PN) as a supplement to EN may increase energy delivery. We aimed to determine if an individually titrated supplemental PN strategy commenced 48-72 hours following ICU admission and continued for up to 7 days would increase energy delivery to critically ill adults compared to usual care EN delivery. Methods: This study was a prospective, parallel group, phase II pilot trial conducted in six intensive care units in Australia and New Zealand. Mechanically ventilated adults with at least one organ failure and EN delivery below 80% of estimated energy requirement in the previous 24 hours received either a supplemental PN strategy (intervention group) or usual care EN delivery. EN in the usual care group could be supplemented with PN if EN remained insufficient after usual methods to optimise delivery were attempted. Results: There were 100 patients included in the study and 99 analysed. Overall, 71% of the study population were male, with a mean (SD) age of 59 (17) years, Acute Physiology and Chronic Health Evaluation II score of 18.2 (6.7) and body mass index of 29.6 (5.8) kg/m2. Significantly greater energy (mean (SD) 1712 (511) calories vs. 1130 (601) calories, p < 0.0001) and proportion of estimated energy requirement (mean (SD) 83 (25) % vs. 53 (29) %, p < 0.0001) from EN and/or PN was delivered to the intervention group compared to usual care. Delivery of protein and proportion of estimated protein requirements were also greater in the intervention group (mean (SD) 86 (25) g, 86 (23) %) compared to usual care (mean (SD) 53 (29) g, 51 (25) %, p < 0.0001). Antibiotic use, ICU and hospital length of stay, mortality and functional outcomes were similar between the two groups. Conclusions: This individually titrated supplemental PN strategy applied over 7 days significantly increased energy delivery when compared to usual care delivery. Clinical and functional outcomes were similar between the two patient groups.

AB - Background: In the critically ill, energy delivery from enteral nutrition (EN) is often less than the estimated energy requirement. Parenteral nutrition (PN) as a supplement to EN may increase energy delivery. We aimed to determine if an individually titrated supplemental PN strategy commenced 48-72 hours following ICU admission and continued for up to 7 days would increase energy delivery to critically ill adults compared to usual care EN delivery. Methods: This study was a prospective, parallel group, phase II pilot trial conducted in six intensive care units in Australia and New Zealand. Mechanically ventilated adults with at least one organ failure and EN delivery below 80% of estimated energy requirement in the previous 24 hours received either a supplemental PN strategy (intervention group) or usual care EN delivery. EN in the usual care group could be supplemented with PN if EN remained insufficient after usual methods to optimise delivery were attempted. Results: There were 100 patients included in the study and 99 analysed. Overall, 71% of the study population were male, with a mean (SD) age of 59 (17) years, Acute Physiology and Chronic Health Evaluation II score of 18.2 (6.7) and body mass index of 29.6 (5.8) kg/m2. Significantly greater energy (mean (SD) 1712 (511) calories vs. 1130 (601) calories, p < 0.0001) and proportion of estimated energy requirement (mean (SD) 83 (25) % vs. 53 (29) %, p < 0.0001) from EN and/or PN was delivered to the intervention group compared to usual care. Delivery of protein and proportion of estimated protein requirements were also greater in the intervention group (mean (SD) 86 (25) g, 86 (23) %) compared to usual care (mean (SD) 53 (29) g, 51 (25) %, p < 0.0001). Antibiotic use, ICU and hospital length of stay, mortality and functional outcomes were similar between the two groups. Conclusions: This individually titrated supplemental PN strategy applied over 7 days significantly increased energy delivery when compared to usual care delivery. Clinical and functional outcomes were similar between the two patient groups.

KW - Clinical nutrition

KW - Critical care

KW - Enteral nutrition

KW - Intensive care

KW - Nutrition therapy

KW - Parenteral nutrition

KW - Randomized controlled trial

UR - http://www.scopus.com/inward/record.url?scp=85043455260&partnerID=8YFLogxK

U2 - 10.1186/s13054-018-1939-7

DO - 10.1186/s13054-018-1939-7

M3 - Article

VL - 22

JO - Critical Care

JF - Critical Care

SN - 1364-8535

IS - 1

M1 - 12

ER -