CARING FOR THE CRITICALLY ILL PATIENT ONLINE FIRST Early Parenteral Nutrition in Critically Ill Patients With Short-term Relative Contraindications to Early Enteral Nutrition A Randomized Controlled Trial

PARENTERAL NUTRITION HAS BEEN in common use since the 1960s and is accepted as the standard of care for patients with chronic nonfunctioning gastrointestinal tracts. In critical illness, controversy surrounds the appropriate use of parenteral nutrition, but largescale trials have begun to answer important questions. Published in2011,EPaNIC(EarlyParenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients) enrolled 4640 critically ill patients to investigate the effects of using parenteral nutrition when enteral nutrition failed to reach a caloric target. EPaNIC did not find any benefits from using additional parenteral nutrition in patients who could receive enteral nutrition; however, many other important questions regarding parenteral nutrition remain. Author Affiliations: Northern Clinical School Intensive Care Research Unit (Dr Doig and Mss Simpson, Sweetman, and Heighes), The George Institute for Global Health (Dr Finfer), University of Sydney, Sydney, Australia; Alfred Hospital, Melbourne, Australia (Drs Cooper and Davies); Royal Prince Alfred Hospital, Sydney (Dr O’Leary); Westmead Hospital, Sydney (Dr Solano); and Queen Elizabeth Hospital, Adelaide, Australia (Dr Peake). The Early PN Trial Contributing Sites and Site Investigators are listed at the end of this article. Corresponding Author: Gordon S. Doig, PhD, Royal North Shore Hospital, Intensive Care Unit, Pacific Hwy, St Leonards, NSW 2065, Australia ([email protected] .edu.au). Caring for the Critically Ill Patient Section Editor: Derek C. Angus, MD, MPH, Contributing Editor, JAMA ([email protected]). Importance Systematic reviews suggest adult patients in intensive care units (ICUs) with relative contraindications to early enteral nutrition (EN) may benefit from parenteral nutrition (PN) provided within 24 hours of ICU admission.