Context

Critically ill patients are hypermetabolic and have increased nutritional requirements. Major international guidelines promote early enteral nutrition (EN), however, up to 35% of all patients remain unfed 3 or more days after intensive care unit (ICU) admission.1 EN is delayed because clinicians believe it is poorly absorbed in critical illness and because they believe excess vomiting may lead to pneumonitis. Parenteral nutrition (PN), an intravenous solution containing glucose, amino acids and lipids, is intuitively appealing because it avoids perceived complications related to gastric dysfunction while providing necessary calories and protein.

A meta-analysis of clinical trials comparing PN with EN …