Posted: May 16, 2019
In their article, Trivez and colleagues (2016) conducted a randomized study to determine whether withholding parenteral nutrition for a week in the pediatric ICU is clinically superior to offering parenteral nutrition. The experiment was a multicenter, prospective, randomized, and controlled one that involved 1440 critically ill children in determining the difference between early and late nutrition. In this group of 1440 patients, 723 of them received early parenteral nutrition (within 24 hours of admission to the ICU) while 717 patients received late parenteral nutrition (nutrition initiated at the morning of the 8th day of admission into ICU). The key endpoints of the trial were the acquisition of a new infection during the ICU stay and the acclimatized duration of ICU dependency. In the two groups, enteral nutrition was tried early with the intravenous micronutrients also being provided.
In this article, there was no clear definition of the research questions or hypothesis as required by a true scientific study. The research design was experimental. During the time of stay in the ICU, the daily records of the patients were kept to ascertain the procedures, treatments, nutrition provided, and the findings of the laboratory analyses. The information on crucial status at 90 days was also obtained from the national death registries, general practitioners’ networks, and the hospital information systems. The analysis was done using the statistical package for social sciences (SPSS). Variables were summarized as percentages and frequencies, medians, interquartile ranges, means, and standard errors. Univariable comparisons were also made using chi-square test and the Wilcoxon rank-sum test. Also, the time-to-event impact size was approximated using Cox proportional-hazards analysis with the data censored at 91 days.
Based on the results obtained, mortality was the same in the two cases. However, the percentage of patients who indicated a new infection was different between the two groups -10.7% for the patients receiving late parenteral nutrition group and 18.5% for the patients receiving late parenteral nutrition. The mean ICU stay was also different between the two groups with that of the late parenteral nutrition group being 6.5±0.4 and that of the one receiving early parenteral nutrition being 9.2±0.8. The researchers also noticed that there was a higher probability of an early discharge from the ICU in the group receiving late parenteral nutritional as compared to the one receiving early parenteral nutrition. Late parenteral nutrition was also related to a shorter duration of artificial ventilator support compared to the early parenteral nutrition. Lower plasma levels were also detected in the late parenteral nutrition than in early parenteral nutrition.
Based on the results of this experiment, withholding parenteral nutrition for a week in the ICU is clinically better than providing early nutrition. The study used scholarly and peer-reviewed references many of which came from the healthcare field. Thus, the study can be said to be reliable and valid. The researchers also used a very large number of participants and are a quantitative study; this number was vital in making a good representation of the population. Also, based on the fact that this study was multicenter, the study can pass the test of external validity. It means it can be generalized to other populations elsewhere since if there can be any differences, they will be minimal. The study can be used in the healthcare to advise the mothers of newborns on how to start of parenteral nutrition for their infants.
Fivez, Tom, et al. "Early versus late parenteral nutrition in critically ill children." New England Journal of Medicine 374.12 (2016): 1111-1122.
Carolyn Morgan is the author of this paper. A senior editor at Melda Research in superior writing services. if you need a similar paper you can place your order for a custom research paper from best custom writing services.
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