
Loading, please wait...

Loading, please wait...

The EPaNIC trial addressed a long-standing nutritional question: should parenteral nutrition be started early when enteral feeding is insufficient, or can it safely be delayed? More than 4,600 critically ill adults were randomised to early or late initiation of parenteral nutrition. Late initiation was associated with faster recovery from the ICU and hospital, fewer ICU infections, less cholestasis and shorter durations of mechanical ventilation and renal-replacement therapy. Mortality was not significantly different. The study challenged the assumption that rapidly closing a calorie deficit with parenteral nutrition necessarily improves outcomes. Instead, in patients who were not chronically malnourished and were receiving early enteral nutrition, the strategy of tolerating a period of nutritional deficit appeared beneficial. EPaNIC therefore influenced modern approaches to nutrition timing and highlighted the importance of distinguishing patients at high nutritional risk from those who can safely receive progressive enteral feeding. For clinicians, the practical message is not to withhold nutrition but to prioritise enteral feeding when feasible and avoid reflexive early parenteral supplementation simply to achieve a prescribed calorie target. Nutritional plans should consider baseline status, illness severity, gut function, metabolic tolerance and expected duration of critical illness. The trial remains central to discussions of nutrition and metabolism in the ICU.

Read summarized clinical updates, watch expert medical content, and earn CME certifications right from your smartphone.


The EPaNIC trial addressed a long-standing nutritional question: should parenteral nutrition be started early when enteral feeding is insufficient, or can it safely be delayed? More than 4,600 critically ill adults were randomised to early or late initiation of parenteral nutrition. Late initiation was associated with faster recovery from the ICU and hospital, fewer ICU infections, less cholestasis and shorter durations of mechanical ventilation and renal-replacement therapy. Mortality was not significantly different. The study challenged the assumption that rapidly closing a calorie deficit with parenteral nutrition necessarily improves outcomes. Instead, in patients who were not chronically malnourished and were receiving early enteral nutrition, the strategy of tolerating a period of nutritional deficit appeared beneficial. EPaNIC therefore influenced modern approaches to nutrition timing and highlighted the importance of distinguishing patients at high nutritional risk from those who can safely receive progressive enteral feeding. For clinicians, the practical message is not to withhold nutrition but to prioritise enteral feeding when feasible and avoid reflexive early parenteral supplementation simply to achieve a prescribed calorie target. Nutritional plans should consider baseline status, illness severity, gut function, metabolic tolerance and expected duration of critical illness. The trial remains central to discussions of nutrition and metabolism in the ICU.
last month

A study demonstrates an explainable machine learning framework integrating clinical and echocardiographic metrics to predict left atrial appendage thrombus in non-valvular atrial fibrillation, utilizing SHAP analysis for clinical interpretability.
4 days back

A systematic review and transcriptomic cross-study consensus analysis illuminates the role of necroptosis in cervical cancer. By promoting anti-tumor immunogenicity and resolving apoptosis resistance, necroptotic pathways offer actionable prognostic signatures and promising avenues for combination immunotherapy.
3 days back

Abdominal aortic aneurysm rupture remains a catastrophic vascular emergency. Groundbreaking research reveals that USP53 accelerates aneurysm progression by reprogramming smooth muscle cell metabolism toward aerobic glycolysis, highlighting a promising target beyond conventional diameter-based surveillance.
Last week

A breakthrough study leverages natural language processing to accurately identify incident medication-related osteonecrosis of the jaw and track antiresorptive drug holidays from clinical narratives in electronic health records, advancing osteoporosis pharmacovigilance and dental safety.
Last week

Recent research defines ferro-aging as a conserved iron-lipid axis driving organ decline across primates. Age-related iron dyshomeostasis stimulates ACSL4-mediated lipid peroxidation, promoting cellular senescence. Notably, vitamin C directly inhibits ACSL4, suppressing phospholipid oxidation and multi-organ decay.
Last week