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Later Parenteral Nutrition Linked to Faster Recovery

Later initiation of parenteral nutrition associated with fewer complications than early initiation

WEDNESDAY, June 29 (HealthDay News) -- Late initiation of parenteral nutrition may have fewer complications and encourage faster recovery than early parenteral nutrition in critically ill adults, according to a study published online June 29 in the New England Journal of Medicine.

Michael P. Casaer, M.D. from the Catholic University of Leuven in Belgium, and colleagues compared the effect of early (European guidelines) versus late initiation (American/Canadian guidelines) of parenteral nutrition to supplement enteral nutrition, on rates of death and complications in adults in the intensive care unit (ICU). The early-initiation group (2,312 subjects) received parenteral nutrition within 48 hours of ICU admission, while the late-initiation group (2,328 subjects) did not receive parenteral nutrition before the eighth day.

The investigators found that, compared with the early-initiation group, patients in the late-initiation group were significantly more likely to be discharged alive earlier from the ICU and the hospital (relative increase of 6.3 percent; hazard ratio, 1.06 and 1.06). The two groups had similar rates of death in the ICU and in the hospital and similar rates of survival at 90 days. The late-initiation group had significantly fewer ICU infections (22.8 versus 26.2 percent) and a significantly lower incidence of cholestasis. There was also a reduction of 9.7 percent in the number of patients needing more than two days of mechanical ventilation, a decrease of three days in the length of renal-replacement therapy and a mean reduction in health care costs of about $1,600 per patient, all of which were significantly reduced compared to the early-initiation group.

"Late initiation of parenteral nutrition was associated with faster recovery and fewer complications, as compared with early initiation," the authors write.

The study was partially funded by an unconditional and nonrestrictive research grant to the university from Baxter Healthcare; one author disclosed receiving consulting and speaking fees from Baxter.

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