,

ESPEN
ESPEN

ESPEN guidelines on
Parenteral Nutrition:
intensive care, Clinical

Nutrition 2009; 28: 387-400

ASPEN
ASPEN

Guidelines for the provision

and assessment of nutrition
support therapy in the adult
critically ill patient: SCCM and
ASPEN: Executive Summary. Crit
Care Med 2009; 37: 175761.

Canadian clinical practice guidelines for nutrition

support in mechanically ventilated, critically ill adult
patients. J Parenter Enteral Nutr 2003; 27: 35573.

Introduction
Mortality rate is higher with the use of:
- early PN alone
- early use of combined PN with EN
Does enteral nutrition compared to parenteral nutrition result
in better outcomes in critically ill adult patients?
A systematic review of the literature. Nutrition 2004; 20: 84348.

Introduction
Tight Calorie Control study (TICACOS)
- Lower hospital discharge mortality
- More infections
- Longer time on mechanical ventilation
The tight calorie control study (TICACOS): a prospective,
randomized, controlled pilot study of nutritional support
in critically ill patients. Intensive Care Med 2011;
37: 60109.

Optimisation of energy
provision with

R3
Supplemental Parenteral Nutrition
in critically ill patients:
A randomized controlled
clinical trial

Methods
Switzerland
- Geneva University hospital.
- Lausanne University hospital.
Mixed medical and surgical ICUs.

Trial Design

Women: 25kcal/kg
Man : 30kcal/kg

EN: 20-30ml/h, up to
maximum 150ml/h.

Exclusion Criteria
Exclusion:
- Receiving PN
- Persistent GI dysfunction
- Ileus
- Pregnant
- Readmission
Care providers and patients were not masked.

Trial Design

Trial Design
EN formula: 1.05-1.62 kcal/ml.
PN formula: 0.62-1.37 kcal/ml.
Continuous IV insulin therapy: <8.5 mmol/L

Trial Endpoints
Occurrence of nosocomial infections after day 8
until day 28.
- Pneumonia
- Bloodstream infection
- Urogenital infection
- Abdominal infection
- Others

Trial Endpoints
Antibiotic days for nosocomial infection.
Antibiotic free days.
Duration of invasive and non-invasive
mechanical ventilation.
Length of stay in ICU and hospital.

Trial Profile
Dec, 2008
Dec, 2010

Demographic

Results
Mean energy delivery:
EN: 20kcal/kg
SPN: 28 kcal/kg
Mean cumulative energy balance

EN: 124 kcal

SPN: - 2317kcal

Results

Nosocomial Infections

Results

41[27%]

58[38%]

Nosocomial infections

Secondary Outcomes

Secondary outcomes
Hypoglycaemia
Hyperglycaemia
Renal replacement therapy

Secondary outcomes
Alkaline Phosphatase concentrations lower in
SPN group (2.01 vs 2.75, p=0.0131).
Decreased of CRP more in SPN group
(959.54 nmol/L vs 667.44 nmol/L, p=0.0180)

Discussion
Delivery of near 100% of energy supply with an
SPN approach can effectively decrease infections
and antibiotic use.

Discussion
Mortality rate is higher with the use of:
- early PN alone
- early use of combined PN with EN
Does enteral nutrition compared to parenteral nutrition result
in better outcomes in critically ill adult patients?
A systematic review of the literature. Nutrition 2004; 20: 84348.

Discussion
Tight Calorie Control study (TICACOS)
- Lower hospital discharge mortality
- More infections
- Longer time on mechanical ventilation
The tight calorie control study (TICACOS): a prospective,
randomized, controlled pilot study of nutritional support
in critically ill patients. Intensive Care Med 2011;
37: 60109.