When, and even whether, to provide nutrition-parenteral or enteral-to critically ill patients is a matter of debate. The authors of a recent study examined the impact of providing patients with parenteral nutrition within 24 hours of admission to the ICU. At 13 ICUs across New Zealand and Australia, patients who were expected to stay in the ICU for at least a day, had a central venous line, were initially unable to receive enteral nutrition, and were unlikely to receive parenteral or oral nutrition the day of or the day after enrollment were randomized to receive either standard care or early parenteral nutrition (686 patients in each group).

Patients in the treatment group received an average of six days of parenteral nutrition (begun a mean of 44 minutes after randomization); 40% of patients also received enteral nutrition for an average of three days. These patients were also given vitamin and mineral supplementation beginning two to three days after the start of parenteral nutrition. In the standard care group, after an average of two to six days, some patients received parenteral nutrition followed by enteral nutrition; others were provided with parenteral nutrition first. A small percentage of patients began receiving enteral and parenteral nutrition at the same time. Almost 41% of the patients in the standard care group received no nutrition at all during their ICU stay.

Analysis of 60-day mortality rates showed no significant difference between the groups. Patients in the treatment group needed invasive mechanical ventilation and experienced clinically significant coagulation failure for significantly fewer days than those in the standard group, but no differences were seen in organ system failure or in infection rates. There were no significant differences in lengths of ICU or overall hospital stay between the two groups, and although quality-of-life scores were higher in the early parenteral nutrition group, the difference wasn't clinically significant. The authors call for further research to determine whether the diminished need for mechanical ventilation confers any benefit over the long term.

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