EPaNIC Brief Summary – Early vs. late parenteral nutrition

ICU Trials by ClinCalc

Ready to improve your ICU knowledge? Check out ICU Trials for iPhone and Android, a pocket reference for 70+ landmark critical care trials, including EPaNIC.

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

Leave a Reply

Your email address will not be published. Required fields are marked *

Note: ClinCalc.com is intended for healthcare providers. Comments regarding personal or patient-specific medical questions or advice will be removed.