Correct Answer: LIES!

In the ICU, parenteral nutrition (PN) is *NOT* associated with increased infection risk compared to enteral nutrition (EN).

But it wasn’t always that way...

#Medtwitter #Medstudenttwitter #nutritionmatters #ICUNutrition https://twitter.com/JonahRubinMD/status/1321182656550359040
Several *old* (latest: 2005) meta-analyses did suggest that pts had fewer infections with EN vs. PN. This led the most recent ASPEN/ @SCCM Guidelines (2015) to “suggest use of EN over PN in critically ill patients who require nutrition support therapy.” https://onlinelibrary.wiley.com/doi/full/10.1177/0148607115621863
In a prescient observation, the @ASPENWEB Guidelines note:

“These differences in outcome...largely reflect findings from older studies and may diminish in the future with improvements in glycemic control, protocolized medical management, and new lipid emulsions.”
And so it came to pass.

The CALORIES trial (NEJM 2014) randomized 2400 medical ICU patients to EN or PN within 36 hrs of admission, for 5 days. There was NO significant difference in mortality, LOS, infections, or aspiration events. Interesting!

https://www.nejm.org/doi/full/10.1056/nejmoa1409860
In a more specific patient population, the NUTRIREA-2 study (Lancet 2018) also randomized 2400 intubated pts, on pressors, to EN vs. PN within 24 hours of intubation, for min. 72 hours. Here too, there was no difference in mortality, LOS, or infections.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32146-3/fulltext
In NUTRIREA-2, the EN group actually had slightly but significantly more bowel ischemia and colonic pseudo-obstruction. Remember, all these patients were in shock.
Also, importantly, pts in NUTRIREA-2 received more kcal/kg than pts in the CALORIES trial (~80 vs ~110), and seemingly higher than would be recommended by both US and European Guidelines. This could be crucial (another tweetorial for another time) in interpreting the results.
In sum, as of now, CALORIES is the only trial that answers the question as I put it - for ICU patients in general - and it seems that parenteral nutrition is *not* more likely to cause an infection than enteral nutrition (for now 😉).
@toddrice_ICU @LifeWithoutDiet @lucymorganRD @ellaterblanche @FOAMecmo @Paul_Wischmeyer @BDACriticalCare - I welcome any additions/corrections! Just starting to find my way around ICU Nutrition twitter!
That's all for now! Will hope to share more about caloric goals in the ICU in the near future.
You can follow @JonahRubinMD.
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