***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: PURPOSE Appropriate caloric intake in critically ill patients receiving enteral nutrition  is controversial . This study evaluates the impact of different caloric regimens on severity of organ failure measured with Sequential Organ Failure Assessment ( SOFA ) . MATERIAL S AND METHODS We conducted a r and omized prospect i ve controlled trial . Study population included adult intensive care unit ( ICU ) patients expected to require enteral nutrition for more than 96 hours . Goals in the intervention group were hypocaloric ( 15 kcal/kg per day ) enteral nutrition compared to normocaloric ( 25 kcal/kg per day ) enteral nutrition , both with hyperproteic intake ( 1.7 g of protein/kg per day ) . Primary end point was change in SOFA score ( ΔSOFA ) from baseline at 48 hours . Secondary end points were ΔSOFA at 96 hours , insulin requirements , hyperglycemia or hypoglycemic episodes , length of ICU stay , days on ventilator , and 28-day mortality . RESULTS After screening 443 patients , 120 patients were analyzed . There were no differences between groups in baseline characteristics . We did not find a statistically significant difference in ΔSOFA at 48 hours . Patients in the hypocaloric group showed lower average daily insulin requirements and percentage of patients requiring any insulin . CONCLUSIONS Hyperproteic , hypocaloric nutrition did not show different outcomes compared to normocaloric nutrition , except lower insulin requirements . Hypocaloric nutrition could provide a more physiologic approach with lower need for care and metabolic impact Purpose Many investigators have reported rising numbers of elderly patients admitted to the intensive care units ( ICUs ) . The aim of the study was to estimate the prevalence of malnutrition risk in the ICU by comparing the prevalence of malnutrition between older adults ( aged 65 years and above ) and adults ( aged 18–64 years ) , and to examine the negative consequences associated with risk of malnutrition in older adults . Material s and methods A prospect i ve cohort study in the ICU of the University Hospital Center of Tirana , Albania , was conducted . Logistic regression analysis was used to analyze the effect of malnutrition risk on the length of ICU stay , the duration of being on the ventilator , the total complications , the infectious complications , and the mortality . Results In this study , 963 patients participated , of whom 459 patients ( 47.7 % ) were aged ≥65 years . The prevalence of malnutrition risk at the time of ICU admission of the patients aged ≥65 years old was 71.24 % . Logistic regression adjusted for confounders showed that malnutrition risk was an independent risk factor of poor clinical outcome for elderly ICU patients , for 1 ) infections ( odds ratio [ OR ] = 4.37 ; 95 % confidence interval [ CI ] : 2.61–7.31 ) ; 2 ) complications ( OR = 6.73 ; 95 % CI : 4.26–10.62 ) ; 3 ) mortality ( OR = 2.68 ; 95 % CI : 1.72–4.18 ) ; and 4 ) ICU length of stay > 14 days ( OR = 5.18 , 95 % CI : 2.43–11.06 ) . Conclusion Malnutrition risk is highly prevalent among elderly ICU patients , especially among severely ill patients with malignancy admitted to the emergency ward . ICU elderly patients at malnutrition risk will have higher complication and infection rates , longer duration of ICU stay , and increased mortality . Efforts should be made to implement a variety of nutritional care strategies , to change the nutritional practice s not only at ward level , but nationally , according to the best clinical practice and recent guidelines Introduction : Our aim was to evaluate the impact of hyperproteic hypocaloric enteral feeding on clinical outcomes in critically ill patients , particularly on severity of organic failure measured with the Sequential Organ Failure Assessment ( SOFA ) . Material s and Methods : In a double blind clinical trial , 80 critically ill adult patients were r and omized to hyperproteic hypocaloric or to isocaloric enteral nutrition ; all patients completed follow-up of at least 4 days . Prescribed caloric intake was : Hyperproteic hypocaloric enteral nutrition ( 15 kcal/kg with 1.7 g/kg of protein ) or isocaloric enteral nutrition ( 25 kcal/kg with 20 % of the calories as protein ) . The main outcome was the differences in delta SOFA at 48 h. Secondary outcomes were intensive care unit ( ICU ) length of stay , days on ventilator , hyperglycemic events , and insulin requirements . Results : There were no differences in SOFA score at baseline ( 7.5 ( st and ard deviation ( SD ) 2.9 ) vs 6.7 ( SD 2.5 ) P = 0.17 ) . The total amount of calories delivered was similarly low in both groups ( 12 kcal/kg in intervention group vs 14 kcal/kg in controls ) , but proteic delivery was significantly different ( 1.4 vs 0.76 g/kg , respectively P ≤ 0.0001 ) . The intervention group showed an improvement in SOFA score at 48 h ( delta SOFA 1.7 ( SD 1.9 ) vs 0.7 ( SD 2.8 ) P = 0.04 ) and less hyperglycemic episodes per day ( 1.0 ( SD 1.3 ) vs 1.7 ( SD 2.5 ) P = 0.017 ) . Discussion : Enteral hyperproteic hypocaloric nutrition therapy could be associated with a decrease in multiple organ failure measured with SOFA score . We also found decreased hyperglycemia and a trend towards less mechanical ventilation days and ICU length of stay 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 evaluate the effect of initial low energy permissive underfeeding ( “ trophic feeding ” ) versus full energy enteral feeding ( “ full feeding ” ) on physical function and secondary outcomes in patients with acute lung injury . Design Prospect i ve longitudinal follow-up evaluation of the NHLBI ARDS Clinical Trials Network ’s EDEN trial Setting 41hospitals in the United States . Participants 525 patients with acute lung injury . Interventions R and omised assignment to trophic or full feeding for up to six days ; thereafter , all patients still receiving mechanical ventilation received full feeding . Measurements Blinded assessment of the age and sex adjusted physical function domain of the SF-36 instrument at 12 months after acute lung injury . Secondary outcome measures included survival ; physical , psychological , and cognitive functioning ; quality of life ; and employment status at six and 12 months . Results After acute lung injury , patients had substantial physical , psychological , and cognitive impairments , reduced quality of life , and impaired return to work . Initial trophic versus full feeding did not affect mean SF-36 physical function at 12 months ( 55 ( SD 33 ) v 55 ( 31 ) , P=0.54 ) , survival to 12 months ( 65 % v 63 % , P=0.63 ) , or nearly all of the secondary outcomes . Conclusion In survivors of acute lung injury , there was no difference in physical function , survival , or multiple secondary outcomes at 6 and 12 month follow-up after initial trophic or full enteral feeding . Trial Registration NCT No 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 Objective : Enteral nutrition is provided to mechanically ventilated patients who can not eat normally , yet the amount of support needed is unknown . We conducted this r and omized , open-label study to test the hypothesis that initial low-volume ( i.e. , trophic ) enteral nutrition would decrease episodes of gastrointestinal intolerance/complications and improve outcomes as compared to initial full-energy enteral nutrition in patients with acute respiratory failure . Design : R and omized , open-label study . Patients : A total of 200 patients with acute respiratory failure expected to require mechanical ventilation for at least 72 hrs . Interventions : Patients were r and omized to receive either initial trophic ( 10 mL/hr ) or full-energy enteral nutrition for the initial 6 days of ventilation . Measurements and Main Results : The primary outcome measure was ventilator-free days to day 28 . Baseline characteristics were similar between the 98 patients r and omized to trophic and the 102 patients r and omized to full-energy nutrition . At enrollment , patients had a mean Acute Physiology and Chronic Health Evaluation II score of 26.9 and a Pao2/Fio2 ratio of 182 and 38 % were in shock . Both groups received similar duration s of enteral nutrition ( 5.5 vs. 5.1 days ; p = .51 ) . The trophic group received an average of 15.8 % ± 11 % of goal calories daily through day 6 compared to 74.8 % ± 38.5 % ( p < .001 ) for the full-energy group . Both groups had a median of 23.0 ventilator-free days ( p = .90 ) and a median of 21.0 intensive-care-unit-free days ( p = .64 ) . Mortality to hospital discharge was 22.4 % for the trophic group vs. 19.6 % for the full-energy group ( p = .62 ) . In the first 6 days , the trophic group had trends for less diarrhea ( 19 % vs. 24 % of feeding days ; p = .08 ) and significantly fewer episodes of elevated gastric residual volumes ( 2 % vs. 8 % of feeding days ; p < .001 ) . Conclusion : Initial troph 
    Output:
    
In conclusion , hypocaloric enteral nutrition had no significantly different effects on morbidity and mortality in critically ill patients when compared with full-energy nutrition .