Early Supplemental Parenteral Nutrition Shortens Ventilation and Intensive Care Unit Stay in ICU Patients Aged ≥60 Years Requiring Mechanical Ventilation: A Randomized Controlled Trial
Abstract
BACKGROUND & AIMS
This study aimed to assess the effects of early supplemental parenteral nutrition (E-SPN) on clinical outcomes in older adults Intensive Care Unit (ICU) patients receiving mechanical ventilation who failed to meet their nutritional requirements through enteral feeding alone.
METHODS
In this prospective randomized controlled trial (RCT), ICU patients aged ≥60 years who achieved <50% of prescribed energy or protein targets from enteral nutrition (EN) by ICU day 3 were enrolled. EN was initiated within 24 hours of ICU admission (prescribed energy target: up to 25 kcal/kg/day based on actual body weight (ABW); protein: 1.2-1.5 g/kg/day) and advanced progressively according to tolerance and metabolic monitoring. Eligible patients were randomized to either the E-SPN group (early supplemental parenteral nutrition, initiated on ICU day 3) or the L-SPN group (late supplemental parenteral nutrition, initiated on ICU day 7).
RESULTS
Ninety-two patients completed the study (E-SPN: 45; L-SPN: 47). Baseline characteristics were comparable between groups. The E-SPN group achieved significantly higher energy and protein intake than the L-SPN group until day 7 (P<0.05). By day 10, serum albumin and prealbumin levels and diaphragm thickness and phosphate levels were higher in the E-SPN group(P<0.05). Early SPN significantly reduced the duration of mechanical ventilation (157.8 ± 54.6 vs. 183.6 ± 61.0 h, P=0.035) and ICU stay (240 vs. 288 h, P=0.015), without affecting…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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