6/28/23, 10:00 PM EPaNIC Pathway Feedback Search Clinical Topics Home Studies EPaNIC EPaNIC Disease Parenteral nutrition Trial question What is the role of late initiation of parenteral nutrition in critically ill patients to supplement insufficient enteral nutrition? Study design Multi-center Open label RCT Population Characteristics of study participants 36.0% female N = 4640 64.0% male 4640 patients (1668 female, 2972 male) Inclusion criteria: adults in the ICU who had a score of 3 on nutritional risk screening Key exclusion criteria: age < 18 years, moribund, do-not-resuscitate code, short bowel syndrome, home ventilation, diabetic coma, pregnancy/lactation, receipt of oral nutrition, BMI < 17, nutritional risk screening score < 3 Interventions N=2328 late parenteral initiation (parenteral nutrition not initiated before day 8) N=2312 early parenteral initiation (parenteral nutrition initiated within 48 hours after ICU admission) Primary outcome Duration of stay in intensive care unit 4.0 days 4 https://web.pathway.md/studies/recZDKo2Mpc51CaKO 1/2 6/28/23, 10:00 PM EPaNIC Pathway 3.0 days 3 2.0 days 1.0 days Significant increase 0.0 days Late parenteral initiation Early parenteral initiation Significant increase in duration of stay in the ICU (3 days vs. 4 days; HR 1.06, 95% CI 1 to 1.13) Secondary outcomes Significant decrease in new infection (22.8% vs. 26.2%; RR 0.87, 95% CI 0.23 to 1.51) Significant increase in duration of hospital stay (14 days vs. 16 days; HR 1.06, 95% CI 1 to 1.13) No significant difference in mechanical ventilation duration (2 days vs. 2 days; HR 1.06, 95% CI 0.99 to 1.12) Safety outcomes No significant differences in death in the ICU and hospital, nutrition-related complication. Significant differences in discharged live from ICU within 8 days (75.2% vs. 71.7%), hypoglycemia during intervention (3.5% vs. 1.9%). Conclusion In adults in the ICU who had a score of 3 on nutritional risk screening, late parenteral initiation was superior to early parenteral initiation with respect to duration of stay in the ICU. Reference Michael P Casaer, Dieter Mesotten, Greet Hermans et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011 Aug 11;365(6):506-17. Open reference URL https://web.pathway.md/studies/recZDKo2Mpc51CaKO 2/2