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Historically, there has been considerable controversy regarding the timing of supplemental parenteral nutrition (PN) in the critical care setting. Guideline recommendations range from continued underfeeding with enteral nutrition (EN) alone for up to 7–10 days1 to the addition of supplemental PN within 24–48 h in patients who are expected to be intolerant to EN within 72 h of admission.2 Proponents of early supplemental PN have focused on data demonstrating that the cumulative energy deficit or caloric debt is associated with adverse clinical outcomes while opponents cite the literature demonstrating increased adverse events in patients who receive PN during their intensive care unit …
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