Trial of the route of early nutritional support in critically ill adults

Trial of the route of early nutritional support in critically ill adults. NEJM, October 2014 [online]

Harvey, S.E., et al.

http://www.nejm.org/doi/full/10.1056/NEJMoa1409860?af=R&rss=currentIssue#t=articleTop

Nutritional support is standard for critically ill patients and requires a complex calculus of timing, route of delivery, and the amount and type of nutrients that are administered — all of which may affect patient outcomes. The interpretation of published meta-analyses of trials comparing nutritional support through the parenteral route versus the enteral route in critically ill patients is complicated by small sample sizes, variable quality, selection bias, lack of standardized definitions, and interventions that combine multiple elements of nutritional support (e.g., timing and route). Currently, the enteral route is the mainstay, largely on the grounds of physiological rationale and modest evidence suggesting an association with fewer infections, yet it can also be associated with gastrointestinal intolerance and underfeeding. The parenteral route, though more invasive, more often secures delivery of the intended nutrition but has been associated with greater risks and rates of complications. However, these studies have not considered improvements in delivery, formulation, and monitoring of parenteral nutrition.