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Summary of the EPaNIC (Casaer 2011) Trial
Early initiation of TPN increased ICU and hospital stay, the incidence of infection, and total healthcare costs. Delaying parenteral nutrition up to 7 days had no effect on mortality.
Key Points from EPaNIC (Casaer 2011)
- Included 4,640 ICU patients with a nutritional risk assessment (NRS) score of 3 or more
- Excluded those taking oral nutrition and BMI < 17
- Randomized patients to early or late parenteral nutrition. Early nutrition consisted of 20% dextrose for 2 days, then full TPN. Late nutrition consisted of 5% dextrose for 7 days, then full TPN. In both groups, TPN was reduced or stopped based on enteral nutrition intake
- Blood glucose levels were maintained between 80 and 110 mg/dL (Leuven I/II protocol)
- Primary efficacy endpoint (ICU length of stay) was slightly improved in patients with late TPN (median 3 vs. 4 days, p=0.02)
- There were no differences in ICU, hospital, or 90-day mortality
- Early TPN associated with higher rate of new infections (22.8% vs. 26.2%, p=0.008, NNH 29), duration of mechanical ventilation, duration of hospitalization, and total healthcare cost (difference of $1600)
Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011 Aug 11;365(6):506-17. PMID 21714640