Timing of Parenteral Nutrition in Critically Ill Patients

Abstract This chapter investigates the timing of parenteral nutrition (PN) initiation in critically ill patients who cannot meet their caloric needs through enteral nutrition alone. The EPaNIC study took place across seven intensive care units (ICUs) in Belgium and compared early PN initiation within 48 hours to later initiation after 7 days. The study showed no significant difference in mortality between the two groups, with the late-initiation group experiencing a shorter ICU stay and fewer infections. Secondary outcomes, including the need for mechanical ventilation and renal replacement therapy, favored the late-initiation group. Finally, the chapter recommends delaying PN initiation until after 7 days in critically ill patients, in line with updated European Society for Clinical Nutrition and Metabolism guidelines to avoid potential harm from early nutritional supplementation.