Early parenteral nutrition vs. standard care in the critically ill patient: A level I randomised controlled trial.

营养支持被接受为住院病人的护理标准，然而，关于如何向危重病人提供营养支持，几乎没有达成一致意见。尽管研究一直将营养不良与更糟糕的结局联系在一起，但向危重患者提供营养支持的情况非常不稳定。虽然人们普遍认为危重患者最好通过胃肠道喂养(胃管喂养)，但对于如果患者不能耐受胃管，何时应该开始静脉人工营养，人们并没有普遍的共识。最近对所有可用的临床试验的系统回顾表明，如果危重患者至少24小时不能通过胃管喂养，他们可能会从静脉人工营养中受益。这不是目前在标准护理下发生的情况。这项多中心随机对照试验的目的是确定早期静脉营养是否可以挽救生命。由于成本和可能增加的感染风险，在澳大利亚早期静脉营养成为常规治疗之前，需要进行这类研究。参与这项研究的知情同意将从患者的近亲或直接从患者本人那里获得。这项研究将由悉尼大学皇家北岸医院管理，并将在18个月内包括26家合作的澳新银行医院。

Nutritional support is accepted as a standard of care for the hospitalised patient however there is little agreement as to how it should be provided to the critically ill patient. Despite the fact that studies consistently link malnutrition to worse outcomes, the provision of nutritional support to the critically ill patient is highly variable. Although there is general agreement that it is best to feed critically ill patients via the gastrointestinal tract (stomach tube feeding), there is no general agreement as to when intravenous artificial nutrition should be begun if a patient cannot tolerate a feeding tube. A recent systematic review of all available clinical trials suggests that if a critically ill patient cannot be fed by a stomach tube for at least 24 hours, they may benefit from intravenous artificial nutrition. This is not what currently happens under standard care. The purpose of this multi-centre randomised controlled trial is to determine if early intravenous nutrition saves lives. Because of the cost, and possible risk of increased infections, a study of this type is required before early intravenous nutrition could become a routine therapy in Australia. Informed consent to participate in the study will be obtained from next of kin, or directly from the patient themselves. The study will be managed at the Royal North Shore Hospital, University of Sydney and will include 26 collaborating ANZ hospitals over 18 months.