***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: Objective : To analyze the effect of an immune enhancing ( IE ) diet on infection and metabolic indices in children with severe head injury fed either an IE or a regular formula . Design : R and omized , blinded , controlled study . Setting : Pediatric intensive care unit in a university hospital . Patients : A total of 40 mechanically ventilated children with severe head injury . Interventions : Within 12 hrs of pediatric intensive care unit admission , patients were r and omized to receive a masked formula : either IE or regular formula . Feedings were advanced to a target volume of energy intake equal to 0.50 % , 100 % , 125 % , 150 % , and 150 % of the predicted basal metabolic rate on days 1–5 . Measurements and Main Results : Nutritional and metabolic indices ; interleukins-1β , -6 , and -8 ; tumor necrosis factor-α ; and outcome end points ( survival , length of stay , length of mechanical ventilation ) were compared between the two groups . Only interleukin-8 levels were lower in the IE group compared with the regular formula group by day 5 ( 23.6 ± 1.5 vs. 35.5 ± 4 pg/mL , p < .04 ) . In multivariate regression analysis , interleukin-8 was also independently negatively correlated with immunonutrition ( p < .04 ) . Nitrogen balance became positive in 30.8 % of patients in the regular formula group and in 69.2 % of patients in the IE group by day 5 ( p < .05 ) . Less gastric cultures were positive in the IE group compared with the regular formula group ( 26.7 % vs. 71.4 % , p < .02 ) . Nosocomial infections ( 15 % vs. 25 % ) , length of stay ( 16.7 vs. 12.2 days ) , length of mechanical ventilation ( 11 vs. 8 days ) , and survival ( 80 % vs. 95 % ) did not differ between groups . Conclusions : Although immunonutrition might decrease interleukin-8 and gastric colonization in children with severe head injury , it might not be associated with additional advantage over the one demonstrated by regular early enteral nutrition Introduction During pressure support ventilation ( PSV ) a part of the breathing pattern is controlled by the patient , and synchronization of respiratory muscle action and the result ing chest wall kinematics is a valid indicator of the patient 's adaptation to the ventilator . The aim of the present study was to analyze the effects of different PSV setting s on ventilatory pattern , total and compartmental chest wall kinematics and dynamics , muscle pressures and work of breathing in patients with acute lung injury . Method In nine patients four different levels of PSV ( 5 , 10 , 15 and 25 cmH2O ) were  r and omly  applied with the same level of positive end-expiratory pressure ( 10 cmH2O ) . Flow , airway opening , and oesophageal and gastric pressures were measured , and volume variations for the entire chest wall , the ribcage and abdominal compartments were recorded by opto-electronic plethysmography . The pressure and the work generated by the diaphragm , rib cage and abdominal muscles were determined using dynamic pressure-volume loops in the various phases of each respiratory cycle : pre-triggering , post-triggering with the patient 's effort combining with the action of the ventilator , pressurization and expiration . The complete breathing pattern was measured and correlated with chest wall kinematics and dynamics . Results At the various levels of pressure support applied , minute ventilation was constant , with large variations in breathing frequency/ tidal volume ratio . At pressure support levels below 15 cmH2O the following increased : the pressure developed by the inspiratory muscles , the contribution of the rib cage compartment to the total tidal volume , the phase shift between rib cage and abdominal compartments , the post-inspiratory action of the inspiratory rib cage muscles , and the expiratory muscle activity . Conclusion During PSV , the ventilatory pattern is very different at different levels of pressure support ; in patients with acute lung injury pressure support greater than 10 cmH2O permits homogeneous recruitment of respiratory muscles , with result ing synchronous thoraco-abdominal expansion BACKGROUND Multiple organ dysfunction syndrome ( MODS ) is a major cause of mortality in intensive care units . A breakdown in gut barrier function and immune dysfunction are associated with the onset of MODS . Probiotic bacteria have been shown to modulate intestinal barrier and immune function . OBJECTIVE This study assessed the efficacy of a probiotic compound in a viable and nonviable formulation in modulating intestinal permeability and immune function and preventing the onset of MODS in patients in the intensive care unit . DESIGN A double-blind , r and omized controlled trial was conducted in the intensive care unit of a tertiary care teaching hospital . Twenty-eight critically ill patients admitted to the intensive care unit were r and omly assigned to receive 1 of 3 treatments daily for 7 d : 1 ) placebo , 2 ) viable probiotics , or 3 ) equivalent probiotic sonicates .  MODS scores and systemic concentrations of immunoglobulin ( Ig ) A and IgG were measured on days -1 , 4 , and 7 , and intestinal permeability measurements were taken daily . RESULTS The patients responded to viable probiotics with a significantly larger increase in systemic IgA and IgG concentrations than in the patients who received placebo or sonicates ( P < 0.05 ) . MODS scores were not significantly affected by probiotic treatment . Over the study period , intestinal permeability decreased in most patients . CONCLUSION Patients receiving viable probiotics show a greater enhancement in immune activity than do patients receiving either placebo or probiotic bacterial sonicates Objective : To assess the effect of isocaloric isonitrogenous parenteral glutamine supplementation on intestinal permeability and nitrogen loss in newborns and infants after major digestive-tract surgery . Summary Background Data : Glutamine supplementation in critically ill and surgical adults may normalize intestinal permeability , attenuate nitrogen loss , improve survival , and lower the incidence of nosocomial infections . Previous studies in critically ill children were limited to very-low-birthweight infants and had equivocal results . Methods : Eighty newborns and infants were included in a double-blind , r and omized trial comparing st and ard parenteral nutrition ( sPN ; n = 39 ) to glutamine-supplemented parenteral nutrition ( GlnPN ; glutamine target intake , 0.4 g kg−1 day−1 ; n = 41 ) , starting on day 2 after major digestive-tract surgery . Primary endpoints were intestinal permeability , as assessed by the urinary excretion ratio of lactulose and rhamnose ( weeks 1 through 4 ) ; nitrogen balance ( days 4 through 6 ) , and urinary 3-methylhistidine excretion ( day 5 ) . Secondary endpoints were mortality , length of stay in the ICU and the hospital , number of septic episodes , and usage of antibiotics and ICU re sources . Results : Glutamine intake plateaued at 90 % of the target on day 4 . No differences were found between patients assigned sPN and patients assigned GlnPN regarding any of the endpoints . Glutamine supplementation was not associated with adverse effects . Conclusions : In newborns and infants after major digestive-tract surgery , we did not identify beneficial effects of isonitrogenous , isocaloric glutamine supplementation of parenteral nutrition . Glutamine supplementation in these patients therefore is not warranted until further research proves otherwise The aim of the study was to analyse the effects of early enteral feeding on the prevention of enterogenic infection in severely burned patients . A total of 22 patients with severe burns were r and omly divided into an early enteral feeding group ( EF ) and a delayed enteral feeding group ( DF ) . The levels of serum endotoxin and TNF-alpha were dynamically detected in the members of both groups , and two unmetabolized sugars ( lactulose and mannitol ) were orally administered to these patients 1 , 3 and 5 days postburn . Intestinal permeability was evaluated by detecting the concentrations of lactulose and mannitol in the urine and the lactulose-mannitol ratio ( L/M ) ratio . The levels of serum endotoxin and TNF-alpha in severely burned patients were significantly higher than in normal subjects ( P<0.01 ) . The endotoxin level was positively related to the TNF-alpha level ( rEF=0.93 , P<0.01 ; rDF=0.80 , P<0.05 ) . The urinary lactulose levels in both groups were significantly higher than in normal ( P<0.01 ) , the urinary mannitol levels showed no obvious changes ( P>0.05 ) . The urinary L/M ratios in both groups were significantly higher than in normal subjects ( P<0.01 ) . The urinary L/M ratio was positively related to the serum endotoxin level ( r=0.95 , P<0.01 ) . The urinary lactulose levels and the urinary L/M ratios in the EF group were significantly lower than in the DF group ( P<0.01 ) . The levels of serum endotoxin and TNF-alpha in the EF group were significantly lower than in the DF group ( P<0.01 ) . It is suggested that intestinal permeability was markedly higher after burns than normal , and was positively related to the gut-derived endotoxemia . Early enteral feeding may decrease intestinal permeability , preserve the intestinal mucosal barrier and have a beneficial effect on the reduction of enterogenic infection BACKGROUND / PURPOSE Nutritional support of surgical patients has improved in recent years because of the possibility of modulating catabolism and anabolism , thus enhancing the immune response and repair processes . The objective of this study was to evaluate metabolic effects of early parenteral nutrition ( PN ) after major surgery . METHODS The authors studied 63 children aged 4 to 14 years with diffuse peritonitis caused by perforated-suppurative appendicitis . They were assigned r and omly to a study group ( SG , n = 31 ) , which received PN for 5 days , starting 24 to 48 hours after surgery or to a control group ( CG , n = 32 ) , that received st and ard treatment ( fluids ) . Weight , C-reactive protein ( CRP ) , albumin , prealbumin , glycemia , nitrogen balance ( NB ) , and insulinlike growth factor ( IGF-I ) , were evaluated on postoperative days 1 , 4 , and 6 . RESULTS Early nutritional support was associated with a significant improvement in NB and IGF-I ( Repeat measures analysis of variance IGF-I , P<.001 and NB P<.01 ) . CONCLUSIONS The authors conclude that early parenteral nutrition has a positive effect on the anabolic response as shown by improved NB and higher IGF-I levels in pediatric patients after major surgery Objective To compare the effect of early enteral feeding using immune-enhancing ( IE ) vs. non-immune-enhancing ( NIE ) formulas on cytokines in children with septic shock . Design and setting A single-center , r and omized , blinded controlled trial in a pediatric intensive care unit of a university hospital . Patients We r and omized 38 patients with septic shock to either IE or NIE . Feedings were advanced to a target volume of energy intake equal to 1/2 , 1 , 5/4 , 6/4 , and 6/4 of the predicted basal metabolic rate on days 1–5 , respectively . Measurements and results Interleukins ( IL ) 1β , 6 , and 8 , tumor necrosis factor α , C-reactive protein , Pediatric Risk of Mortality ( PRISM ) score , survival , secondary infections , length of stay , and mechanical ventilation were compared within and between the two groups . Actual mean energy and protein intakes did not differ between the two groups and the caloric-protein balance was not correlated to cytokine levels . On day 5 IL-6 levels were significantly lower ( 11.8±2.4 vs. 38.3±3.6 ) and IL-8 significantly higher in the IE than in the NIE group ( 65.4±17 vs. 21±2.5 ) . After 5 days of nutritional support a significant decrease in IL-6 levels was recorded only in group IE ( mean of paired differences 39.4±3 pg/ml ) . In multivariate regression analysis the variation in cytokines was independently correlated only to PRISM ( R2=−0.50 ) , but pediatric intensive care unit outcome endpoints did not differ between the two groups . Conclusions Early IE nutrition may modulate cytokines in children with septic shock , but there is no evidence that this immunomodulation has any impact on short-term outcome Objectives : To measure energy expenditure in critically ill children and compare it with the energy expenditure predicted by recommended formulas , and relate the measured energy expenditure to nutritional and clinical indices . Design : A prospect i ve , clinical study . Setting : Tertiary care pediatric intensive care unit in a university children 's hospital . Patients : A total of 37 patients with critical illness who were mechanically ventilated for ≥24 hrs were studied . Interventions : None . Measurements and Main Results : Chronic protein‐energy malnutrition ( CPEM ) and acute protein‐energy malnutrition were defined by the Waterlow 's stages and fat and protein stores were classified as defined by Frisancho , Ryan , and Martinez . Severity 
    Output:
    
the mortality rate is different in children who are given enteral nutrition alone versus enteral and parenteral combined;4 .
the mortality rate is different in children who are given both enteral feeds and parenteral nutrition versus no nutrition .
No statistically significant differences were observed for mortality , sepsis , ventilator days , length of stay , unexpected adverse events , resting energy expenditure , nitrogen balance , or albumin levels .