Tubed? No nasogastric? Eat later…

What is a healthy diet, when you’re being fed through a drip? A great deal of research goes into nutrition, including parenteral nutrition, in critical care, but less clear is the ideal timing of initiation. It’s well known that enteral nutrition is a better option when you can – but it doesn’t always meet your requirements. So, when do you start the TPN?



NEJM delves deeper in this issue thanks to Casaer and colleagues, who looked at early vs. late initiation of parenteral nutrition. The Europeans are a fan of the former, whereas the American/Canadian guidelines recommend the latter. 


Late initiators had a shorter length of stay, which was the primary outcome, but also dropped the cost of care by about $1,600 (US). The late initiators also collected less infections, and spent less time on the ventilator and the filter. There was a higher degree of acute inflammation, and mortality was no different between the groups. 


General favour then towards later feeding – have a glance over here


IMAGE Joshua Kaufman

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