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Randomized evidence from the EPaNIC trial examined whether initiating parenteral nutrition early in critically ill patients who were not receiving sufficient enteral nutrition improved outcomes. Delaying supplemental parenteral nutrition until later in the ICU course shortened the duration of organ dysfunction and accelerated recovery compared with early parenteral supplementation. The findings influenced modern nutritional-support strategies by emphasizing that calorie delivery is not the only outcome that matters. For internists and intensivists, enteral feeding is generally preferred when the gastrointestinal tract is functional, with attention to tolerance and protein provision. Early nutrition should not become an excuse for aggressive feeding in hemodynamically unstable patients. Instead, nutrition must be integrated with the patient's overall physiology, glycemic control and risk of refeeding or aspiration. The study is valuable because it shows that “more nutrition sooner” is not necessarily better and that the timing and route of support can influence recovery independently of the nominal calorie target.
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Randomized evidence from the EPaNIC trial examined whether initiating parenteral nutrition early in critically ill patients who were not receiving sufficient enteral nutrition improved outcomes. Delaying supplemental parenteral nutrition until later in the ICU course shortened the duration of organ dysfunction and accelerated recovery compared with early parenteral supplementation. The findings influenced modern nutritional-support strategies by emphasizing that calorie delivery is not the only outcome that matters. For internists and intensivists, enteral feeding is generally preferred when the gastrointestinal tract is functional, with attention to tolerance and protein provision. Early nutrition should not become an excuse for aggressive feeding in hemodynamically unstable patients. Instead, nutrition must be integrated with the patient's overall physiology, glycemic control and risk of refeeding or aspiration. The study is valuable because it shows that “more nutrition sooner” is not necessarily better and that the timing and route of support can influence recovery independently of the nominal calorie target.
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