would improve outcome as,1.observed association between poor nutritional status and clinical outcome2.NS improves the markers of malnutrition3.obvious fact that death will follow an indefinite period of no nutrition4.retrospective / prospective reports of efficacy5.perspective that doing something is better than nothinghowever, appealing as these are,1.
does not prove causationmalnutrition may be a marker of more severe disease, not a cause2.improvement of markers of nutrition does not necessarily correlate with improvedclinical outcome3.death 2° to malnutrition only occurs in extreme circumstances4.uncontrolled trials do not support interventional efficacy5.these abnormalities are a
to injury, preserved by evolutionmost of the clinical trials of NS/PNS
been able to demonstrate improved outcomeconversely, several have shown increased risk of
, especially in the settings of cancerchemotherapy and surgerymeta-analysis of perioperative PNS trials have suggested a reduction in perioperative morbidityby 5%
reviewing PRCT's of NS versus no support, concluded "although it is likely NS willnot provide dramatic benefit, these trials are inadequate to prove that NS has nobenefit at all"ie, possiblity of type II errorcomparative studies of PNS versus ENS have shown with PNS,1.higher death rate2.more infective complicationsone study only showed an advantage with PNS, however they used bolus feeds through largebore NG tubes
this data could not be reproduced when repeated with continuous, higher density feeds, giventhrough fine bore tubes
ICU - Nutrition