***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Despite extensive use of enteral ( EN ) and parenteral nutrition ( PN ) in intensive care unit ( ICU ) population s for 4 decades , evidence to support their efficacy is extremely limited . METHODS A prospect i ve r and omized trial was conducted evaluate the impact on outcomes of intensive medical nutrition therapy ( IMNT ; provision of > 75 % of estimated energy and protein needs per day via EN and adequate oral diet ) from diagnosis of acute lung injury ( ALI ) to hospital discharge compared with st and ard nutrition support care ( SNSC ; st and ard EN and ad lib feeding ) . The primary outcome was infections ; secondary outcomes included number of days on mechanical ventilation , in the ICU , and in the hospital and mortality . RESULTS Overall , 78 patients ( 40 IMNT and 38 SNSC ) were recruited . No significant differences between groups for age , body mass index , disease severity , white blood cell count , glucose , C-reactive protein , energy or protein needs occurred . The IMNT group received significantly higher percentage of estimated energy ( 84.7 % vs 55.4 % , P < .0001 ) and protein needs ( 76.1 vs 54.4 % , P < .0001 ) per day compared with SNSC . No differences occurred in length of mechanical ventilation , hospital or ICU stay , or infections . The trial was stopped early because of significantly greater hospital mortality in IMNT vs SNSC ( 40 % vs 16 % , P = .02 ) . Cox proportional hazards models indicated the hazard of death in the IMNT group was 5.67 times higher ( P = .001 ) than in the SNSC group . CONCLUSIONS Provision of IMNT from ALI diagnosis to hospital discharge increases mortality BACKGROUND Nutritional support has been recognized as an essential part of intensive care unit management . However , the appropriate caloric intake for critically ill patients remains ill defined . OBJECTIVE We examined the effect of permissive underfeeding compared with that of target feeding and of intensive insulin therapy ( IIT ) compared with that of conventional insulin therapy ( CIT ) on the outcomes of critically ill patients . DESIGN This study had a 2 × 2 factorial , r and omized , controlled design . Eligible patients were r and omly assigned to permissive underfeeding or target feeding groups ( caloric goal : 60 - 70 % compared with 90 - 100 % of calculated requirement , respectively ) with either IIT or CIT ( target blood glucose : 4.4 - 6.1 compared with 10 - 11.1 mmol/L , respectively ) . RESULTS Twenty-eight-day all-cause mortality was 18.3 % in the permissive underfeeding group compared with 23.3 % in the target feeding group ( relative risk : 0.79 ; 95 % CI : 0.48 , 1.29 ; P = 0.34 ) . Hospital mortality was lower in the permissive underfeeding group than in the target group ( 30.0 % compared with 42.5 % ; relative risk : 0.71 ; 95 % CI : 0.50 , 0.99 ; P = 0.04 ) . No significant differences in outcomes were observed between the IIT and CIT groups . CONCLUSION In critically ill patients , permissive underfeeding may be associated with lower mortality rates than target feeding . This trial was registered at controlled-trials.com as IS RCT N96294863 Objective : To describe current nutrition practice s in intensive care units and determine “ best achievable ” practice relative to evidence -based Critical Care Nutrition Clinical Practice Guidelines . Design : An international , prospect i ve , observational , cohort study conducted January to June 2007 . Setting : One hundred fifty-eight adult intensive care units from 20 countries . Patients : Two-thous and nine-hundred forty-six consecutively enrolled mechanically ventilated adult patients ( mean , 18.6 per site ) who stayed in the intensive care unit for at least 72 hrs . Interventions : Data on nutrition practice s were collected from intensive care unit admission to intensive care unit discharge or a maximum of 12 days . Measurements and Main Results : Relative to recommendations of the Clinical Practice Guidelines , we report average , best , and worst site performance on key nutrition practice s. Adherence to Clinical Practice Guideline recommendations was high for some recommendations : use of enteral nutrition in preference to parenteral nutrition , glycemic control , lack of utilization of arginine-enriched enteral formulas , delivery of hypocaloric parenteral nutrition , and the presence of a feeding protocol . However , significant practice gaps were identified for other recommendations . Average time to start of enteral nutrition was 46.5 hrs ( site average range , 8.2–149.1 hrs ) . The average use of motility agents and small bowel feeding in patients who had high gastric residual volumes was 58.7 % ( site average range , 0%–100 % ) and 14.7 % ( site average range , 0%–100 % ) , respectively . There was poor adherence to recommendations for the use of enteral formulas enriched with fish oils , glutamine supplementation , timing of supplemental parenteral nutrition , and avoidance of soybean oil-based parenteral lipids .  Average nutritional adequacy was 59 % ( site average range , 20.5%–94.4 % ) for energy and 60.3 % ( site average range , 18.6%–152.5 % ) for protein . Conclusions : Despite high adherence to some recommendations , large gaps exist between many recommendations and actual practice in intensive care units , and consequently nutrition therapy is suboptimal . We have identified “ best achievable ” practice that can serve as targets for future quality improvement initiatives A prospect i ve study was carried out over a 10-month period to compare nutritional status , gastric colonization , and rates of nosocomial pneumonia in intensive care unit ( ICU ) patients r and omized to either gastric tube feeding or feeding by an endoscopically placed jejunal tube . Sixty-nine patients were considered eligible for the study . Thirty-eight patients were enrolled from medical and surgical ICUs at two hospitals and were equally divided into two groups . The groups were similar in age , sex , race , underlying disease , type of surgical procedure , number of days fed , duration of ICU stay , duration of mechanical ventilation , days with fever , and days of antibiotic therapy . The jejunal tube ( JT ) group had more patients who were in circulatory shock on admission ( 79 % ) than the gastric feeding ( GT ) group ( 68.4 % ) . Additionally , the JT group had higher Acute Physiology Scores ( 24.0 vs 21.7 ) and fewer  patients with pneumonia  at the time of entry into the study ( 26.3 % us 31.6 % ) . The JT patients received a signi Objective : To determine whether medical intensive care unit ( ICU ) patients receiving nasoduodenal ( ND ) feedings  achieve optimal nutritional support and better clinical outcomes compared with patients receiving nasogastric ( NG ) feedings .  Design : A prospect i ve , r and omized , clinical study . Setting : Medical ICU of a university-affiliated tertiary medical center . Patients : One hundred twenty-one medical ICU patients required enteral feeding . Interventions : Patients were r and omized to receive enteral feeding .  One group received ND feedings and the other group received NG feedings . All patients followed the same protocol . Measurements and Main Results : The primary outcome of optimal nutritional support was assessed by measurement of time to goal tube feed rate and daily calorie and protein intake . Secondary clinical outcomes included number of ICU , hospital and ventilator days , number of the days in the study , blood – glucose levels , incidence of vomiting , diarrhea , gastrointestinal bleeding , tube replaced , tube clogged , fever , bacteremia , and ventilator-associated pneumonia ( VAP ) , and mortality rate . Results showed that the ND group had a higher average daily calorie and protein intake compared with NG group and achieved nutritional goals earlier . In terms of clinical outcomes , patients in the ND group had a lower rate of vomiting and VAP . The other clinical outcomes such as number of ICU days , hospital days , ventilator days , blood – glucose level , tube replaced or clogged , diarrhea , gastrointestinal bleeding , fever , bacteremia , and mortality rate were not significantly different between two groups . Conclusions : Patients who received ND feedings achieved nutritional goals earlier than those who received NG feeding . ND feeding group also has a lower rate of vomiting and VAP in the medical ICU setting Introduction Current international sepsis guidelines recommend low-dose enteral nutrition ( EN ) for the first week . This contradicts other nutrition guidelines for heterogenous groups of ICU patients . Data on the optimal dose of EN in septic patients are lacking . Our aim was to evaluate the effect of energy and protein amount given by EN on clinical outcomes in a large cohort of critically ill septic patients . Methods We conducted a secondary analysis of pooled data collected prospect ively from international nutrition studies . Eligible patients had a diagnosis of sepsis and /or pneumonia and were admitted to the ICU for ≥3 days , mechanically ventilated within 48 hours of ICU admission and only receiving EN . Patients receiving parenteral nutrition were excluded . Data were collected from ICU admission up to a maximum of 12 days . Regression models were used to examine the impact of calorie and protein intake on 60-day mortality and ventilator-free days . Results Of the 13,630 patients included in the data set , 2,270 met the study inclusion criteria . Patients received a mean amount of 1,057 kcal/d ( 14.5 kcal/kg/day ) and 49 g protein/day ( 0.7 g/kg/d ) by EN alone . Patients were mechanically ventilated for a median of 8.4 days and 60-day mortality was 30.5 % . An increase of 1,000 kcal was associated with reduced 60-day mortality ( odds ratio ( OR ) 0.61 ; 95 % confidence interval ( CI ) 0.48 to 0.77 , P < 0.001 ) and more ventilator-free days ( 2.81 days , 95 % CI 0.53 to 5.08 , P = 0.02 ) as was an increase of 30 g protein per day ( OR 0.76 ; 95 % CI 0.65 to 0.87 , P < 0.001 and 1.92 days , 95 % CI 0.58 to 3.27 , P = 0.005 , respectively ) . Conclusions In critically ill septic patients , a calorie and protein delivery closer to recommended amounts by EN in the early phase of ICU stay was associated with a more favorable outcome BACKGROUND Proper caloric intake goals in critically ill surgical patients are unclear . It is possible that overnutrition can lead to hyperglycemia and an increased risk of infection . OBJECTIVE This study was conducted to determine whether surgical infection outcomes in the intensive care unit ( ICU ) could be improved with the use of hypocaloric nutritional support . DESIGN Eighty-three critically ill patients were r and omly allocated to receive either the st and ard calculated daily caloric requirement of 25 - 30 kcal · kg(-1 ) · d(-1 ) ( eucaloric ) or 50 % of that value ( hypocaloric ) via enteral tube feeds or parenteral nutrition , with an equal protein allocation in each group ( 1.5 g · kg(-1 ) · d(-1 ) ) . RESULTS There were 82 infections in the hypocaloric group and 66 in the eucaloric group , with no significant difference in the mean ( ± SE ) number of infections per patient ( 2.0 ± 0.6 and 1.6 ± 0.2 , respectively ; P = 0.50 ) , percentage of patients acquiring infection [ 70.7 % ( 29 of 41 ) and 76.2 % ( 32 of 42 ) , respectively ; P = 0.57 ] , mean ICU length of stay ( 16.7 ± 2.7 and 13.5 ± 1.1 d , respectively ; P = 0.28 ) , mean hospital length of stay ( 35.2 ± 4.9 and 31.0 ± 2.5 d , respectively ; P = 0.45 ) , mean 0600 glucose concentration ( 132 ± 2.9 and 135 ± 3.1 mg/dL , respectively ; P = 0.63 ) , or number of mortalities [ 3 ( 7.3 % ) and 4 ( 9.5 % ) , respectively ; P = 0.72 ] . Further analyses revealed no differences when analyzed by sex , admission diagnosis , site of infection , or causative organism . CONCLUSIONS Among critically ill surgical patients , caloric provision across a wide acceptable range does not appear to be associated with major outcomes , including infectious complications . The optimum target for caloric provision remains elusive BACKGROUND AND AIMS Critically ill patients with complicated evolution are frequently hypermetabolic , catabolic , and at risk of underfeeding . The study aim ed at assessing the relationship between energy balance and outcome in critically ill patients . METHODS Prospect i ve observational study conducted in consecutive patients staying > or = 5 days in the surgical ICU of a University hospital .  Demographic data , time to feeding , 
    Output:
    
Delivery of increased calories via the enteral route , with or without supplemental PN , was not associated with a survival benefit