Early nutritional strategies in ICU: Comparing mortality and outcomes of enteral versus parenteral nutrition

Abstract

Introduction: Critical illness often leads to a hypermetabolic state, increasing the risk of malnutrition, which can exacerbate patient outcomes in the ICU. The choice between early enteral nutrition (EN) and early parenteral nutrition (PN) remains a debated topic, with conflicting evidence on their impact on mortality and other clinical outcomes. This study aims to compare the effects of early EN and PN on ICU mortality, length of stay (LOS), and duration of mechanical ventilation in critically ill patients. Methods: A retrospective observational study was conducted in the ICU of Wahidin Sudirohusodo Hospital, Makassar, Indonesia, from April 2022 to March 2023. A total of 752 patients were included in the final analysis after applying exclusion criteria. Patients were divided into two groups based on the type of early nutritional support received: early EN (n=293) and early PN (n=459). Baseline characteristics, nutritional intake, and clinical outcomes were assessed. Result: The study found that patients in the early EN group had significantly lower ICU mortality (17.1% vs. 27.9%, p<0.001), shorter ICU LOS (median 3 days vs. 4 days, p<0.001), and reduced duration of mechanical ventilation (median 1 day vs. 2 days, p<0.001) compared to the early PN group. Despite higher caloric intake in the PN group (8.6 kcal/kg/day vs. 6.6 kcal/kg/day, p=0.001), this did not translate into better outcomes. Conclusion: Early enteral nutrition is associated with improved survival, shorter ICU stay, and decreased mechanical ventilation duration compared to early parenteral nutrition. Clinicians should prioritize EN in the management of critically ill patients while cautiously evaluating the indications for PN.

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