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Guidelines differ substantially in their recommendations about when to start parenteral nutrition in critically ill patients; these guidelines are based primarily on expert opinion. To evaluate prospectively the optimal timing of nutritional support, investigators in Belgium randomized 4640 nutritionally at-risk patients in the intensive care unit (ICU; ~85% surgical patients, including 60% who underwent cardiac surgery) to receive early initiation (ICU day 3) or late initiation (ICU day 8) of parenteral nutrition. The study was not blinded, but allocation was concealed.
Although no differences were noted in mortality (ICU, in-hospital, or 90-day) between the groups, the late-initiation group had significantly shorter lengths of stay (LOS) i…