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The CALORIES study is a controlled, randomized, pragmatic, open, multicenter, parallel group investigation with an integrated economic assessment of 2400 critically ill patients. The objective of this study was to evaluate the effect of parenteral nutrition therapy (PNT) and enteral nutritional therapy (ENT) on 30-day mortality and the cost-effectiveness of the two nutritional support modalities in one year.
The authors offered for 5 days early nutritional therapy by parenteral (n = 1200) and enteral routes (n = 1200). At the end of the study, there was no significant difference between the two nutritional therapy modalities in relation to 30-day mortality. On average, costs were higher for PNT, which, combined with similar survival and quality of life, resulted in negative cost-effectiveness in one year.
In 30 days, mortality was 33.1% (393 of 1188) in patients who received early PNT and 34.2% (409 of 1195) in those with ENT. The proportion of patients in the PNT group whit episodes of hypoglycemia (p = 0.006) and vomit (p <0.001) was significantly lower than in the ENT group. There were no significant differences in relation to infectious and noninfectious complications.
Nutritional therapy comprises a complex combination of time, dose, duration, delivery and type, all of which may affect clinical outcomes and costs. The evidence regarding the optimal provision for critically ill patients is still conflicting. This study suffers from being open and making the decision to give PNT or ENT regardless of the patient's digestive condition.
REFERENCE: Harvey SE, Parrott F, Harrison DA, Sadique MZ, Grieve RD, Canter RR, et al. A multicenter randomized controlled trial comparing the clinical effectiveness and cost-effectiveness of early nutritional support via the parenteral versus the enteral route in critically ill patients (CALORIES). Health Technol Assess. 2016;20:1-144.