Critical Illness

CI: Enteral Nutrition vs. Parenteral Nutrition (2012)

• Intervention
  In adult patients who are critically ill, what is the effect of enteral nutrition (EN) vs. parenteral nutrition (PN) on mortality?

  • Conclusion

    It is unclear whether there is a difference in mortality rate when comparing EN vs. PN in critically ill adult patients.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In adult patients who are critically ill, what is the effect of enteral nutrition (EN) vs. parenteral nutrition (PN) on mortality?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN. 2003; 27: 355-373.
      • Kutsogiannis J, Alberda C, Gramlich L, Cahill NE, Wang M, Day AG, Dhaliwal R, Heyland DK. Early use of supplemental parenteral nutrition in critically ill patients: Results of an international multicenter observational study. Crit Care Med. 2011 Jul 14. [Epub ahead of print] PMID: 21765355.
      • Simpson F and Doig GS. Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle. Intensive Care Med. 2005; 31: 12-23.
  • Search Plan and Results: CI: EN vs. PN 2011
     
  In adult patients who are critically ill, what is the effect of enteral nutrition (EN) vs. parenteral nutrition (PN) on infectious complications?

  • Conclusion

    When compared to PN, EN is associated with reductions in infectious complications in critically ill adult patients.

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In adult patients who are critically ill, what is the effect of enteral nutrition (EN) vs. parenteral nutrition (PN) on infectious complications?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN. 2003; 27: 355-373.
      • Simpson F and Doig GS. Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle. Intensive Care Med. 2005; 31: 12-23.
  • Search Plan and Results: CI: EN vs. PN 2011
     
  In adult patients who are critically ill, what is the effect of enteral nutrition (EN) vs. parenteral nutrition (PN) on length of stay (LOS)?

  • Conclusion

    There is limited evidence that early EN vs. PN decreases hospital LOS in critically ill adult patients.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In adult patients who are critically ill, what is the effect of enteral nutrition (EN) vs. parenteral nutrition (PN) on length of stay?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Kutsogiannis J, Alberda C, Gramlich L, Cahill NE, Wang M, Day AG, Dhaliwal R, Heyland DK. Early use of supplemental parenteral nutrition in critically ill patients: Results of an international multicenter observational study. Crit Care Med. 2011 Jul 14. [Epub ahead of print] PMID: 21765355.
  • Search Plan and Results: CI: EN vs. PN 2011
     
  In adult patients who are critically ill, what is the effect of enteral nutrition (EN) vs. parenteral nutrition (PN) on cost of care?

  • Conclusion

    No new studies were identified in the update. When compared to PN, EN is associated with reduced cost of medical care in critically ill adult patients.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In adult patients who are critically ill, what is the effect of enteral nutrition (EN) vs. parenteral nutrition (PN) on cost of care?
    • Detail
  • Search Plan and Results: CI: EN vs. PN 2011