***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: Introduction Early protein and energy feeding in critically ill patients is heavily debated and early protein feeding hardly studied . Methods A prospect i ve data base with mixed medical-surgical critically ill patients with prolonged mechanical ventilation ( > 72 hours ) and measured energy expenditure was used in this study . Logistic regression analysis was used to analyse the relation between admission day-4 protein intake group ( with cutoffs 0.8 , 1.0 , and 1.2 g/kg ) , energy overfeeding ( ratio energy intake/measured energy expenditure > 1.1 ) , and admission diagnosis of sepsis with hospital mortality after adjustment for APACHE II ( Acute Physiology and Chronic Health Evaluation II ) score . Results A total of 843 patients were included . Of these , 117 had sepsis . Of the 736 non-septic patients 307 were overfed . Mean day-4 protein intake was 1.0 g/kg pre-admission weight per day and hospital mortality was 36 % . In the total cohort , day-4 protein intake group ( odds ratio ( OR ) 0.85 ; 95 % confidence interval ( CI ) 0.73 to 0.99 ; P = 0.047 ) , energy overfeeding ( OR 1.62 ; 95%CI 1.07 to 2.44 ; P = 0.022 ) , and sepsis ( OR 1.77 ; 95%CI 1.18 to 2.65 ; P = 0.005 ) were independent risk factors for mortality besides APACHE II score . In patients with sepsis or energy overfeeding , day-4 protein intake was not associated with mortality . For non-septic , non-overfed patients ( n = 419 ) , mortality decreased with higher protein intake group : 37 % for < 0.8 g/kg , 35 % for 0.8 to 1.0 g/kg , 27 % for 1.0 to 1.2 g/kg , and 19 % for ≥1.2 g/kg ( P = 0.033 ) . For these , a protein intake level of ≥1.2 g/kg was significantly associated with lower mortality ( OR 0.42 , 95%CI 0.21 to 0.83 , P = 0.013 ) . Conclusions In non-septic critically ill patients , early high protein intake was associated with lower mortality and early energy overfeeding with higher mortality . In septic patients early high protein intake had no beneficial effect on mortality OBJECTIVES To describe current enteral nutrition-prescribing practice s for critically ill patients , and to identify factors associated with initiation of , and tolerance to , enteral nutrition . DESIGN A prospect i ve , cohort study . SETTING Two tertiary care medical-surgical intensive care units ( ICU ) in Ontario , Canada . PATIENTS We enrolled 99 consecutive patients who were expected to stay in the ICU for > 3 days and who were unable to tolerate oral nutrition .  We followed patients for 21 days or until they tolerated enteral nutrition , tolerated oral nutrition , were discharged from the ICU , or died . MEASUREMENTS AND MAIN RESULTS We recorded time elapsed from ICU admission to initiation and tolerance of enteral feedings , and examined factors associated with these events . We defined tolerance as receiving 90 % of estimated daily energy requirements for > 48 hrs without gastrointestinal dysfunction ( i.e. , high gastric residuals , vomiting , diarrhea , abdominal distention ) . Seventy-three ( 74 % ) of 99 patients were started on enteral feedings an average 3.1 days ( range 1 to 18 ) after ICU admission . Of 26 patients never started on enteral nutrition , three ( 12.5 % ) patients eventually tolerated oral nutrition , 14 ( 54.0 % ) patients were discharged from the ICU , and seven ( 27.0 % ) patients died . Reasons for not initiating enteral nutrition included absence of bowel sounds ( 27.0 % ) , high nasogastric drainage ( 16.9 % ) , contraindication to enteral nutrition ( 16.7 % ) , tolerance of oral nutrition ( 6.8 % ) , and no apparent reason ( 5.1 % ) . Abdominal surgery , use of vasoactive drugs , and admission to one hospital made initiation of enteral nutrition less likely , whereas presence of bowel sounds and admission to the other hospital made initiation of enteral nutrition more likely . Thirty-five ( 42.9 % ) of 73 patients started on enteral nutrition achieved tolerance of the regimen . The average time from ICU admission to tolerance of feedings was 5.8 days ( range 1 to 14 ) . Once started on enteral nutrition , the most common reasons for decreasing or discontinuing feedings included high gastric residuals ( 51.0 % ) , mechanical feeding tube problems ( 15.4 % ) , medical or surgical procedures ( 5.4 % ) , and vomiting ( 5.1 % ) . Use of paralytic agents and the presence of high gastric residuals were associated with intolerance . Of 38 patients who did not achieve tolerance , 20 ( 52.6 % ) patients were discharged from the ICU , eight ( 21.0 % ) patients died , and eight ( 21.0 % ) patients eventually tolerated oral nutrition . CONCLUSIONS Enteral nutrition is not started in all eligible ICU patients . Approximately half of those patients receiving enteral nutrition achieved tolerance of the regimen . Gastrointestinal dysfunction causing intolerance to enteral nutrition is a common reason for not starting , or discontinuing , feedings BACKGROUND Our goal is to define nutrition therapy in critically ill patients after surgical repair of acute ruptured or dissecting aortic aneurysm to identify opportunities for quality improvement . METHODS International , prospect i ve studies in 2007 - 2009 and 2011 were combined . Sites provided institutional and patient characteristics including from intensive care units ( ICUs ) admission to ICU discharge for a maximum of 12 days . We selected patients with aortic aneurysmal rupture or acute dissection staying in the ICU for ≥ 3 days . RESULTS There were 104 eligible patients from 72 distinct ICUs analyzed . Overall , 86.5 % received artificial nutrition . There were 50.0 % patients who received enteral nutrition ( EN ) only , 29.8 % patients received a combination of EN and parenteral nutrition ( PN ) , 6.7 % patients received PN only , and 13.5 % did not receive any nutrition . The mean time from admission to initiation of EN was 3.0 days ( SD ± 2.4 days ) . The adequacy of calories from nutrition support was 46.8 % ( range 0%-111 % ) with a mean of 10.0 kcal/kg/day . Of the total of 83 patients who received EN , 53 patients ( 63.8 % ) had interruption of EN . The reasons included fasting , intolerance , patients deemed too sick for enteral feeding , and loss of enteral feeding route . For patients with gastrointestinal intolerance , 3/30 patients ( 10 % ) received small bowel feeding and 23/30 patients ( 76.7 % ) of patients received motility agents . CONCLUSION Postoperative critically ill patients with aortic aneurysmal rupture or acute dissection are at high risk for inadequate nutrition therapy , and there may be inadequate utilization of strategies to improve nutrition uptake BACKGROUND The open abdomen is a requisite component of a damage control operation and treatment of abdominal compartment syndrome .  Enteral nutrition ( EN ) has proven beneficial for patients with critical injury , but its application in those with an open abdomen has not been defined . The purpose of this study was to analyze the use of EN for patients with an open abdomen after trauma and the effect of EN on fascial closure rates and nosocomial infections . METHODS We review ed patients with an open abdomen after injury from January 2002 to January 2009 from 11 trauma centers . RESULTS During the 7-year study period , 597 patients required an open abdomen after trauma . Most were men ( 77 % ) sustaining blunt trauma ( 72 % ) , with a mean ( SD ) age of 38 ( 0.7 ) years , an Injury Severity Score of 31 ( 0.6 ) , an abdominal injury score of 3.8 ( 0.1 ) , and an Abdominal Trauma Index score of 26.8 ( 0.6 ) . Of the patients , 548 ( 92 % ) had an open abdomen after a damage control operation , whereas the remainder experienced an abdominal compartment syndrome . Of the 597 patients , 230 ( 39 % ) received EN initiated before the closure of the abdomen at mean ( SD ) day 3.6 ( 1.2 ) after injury . EN was started with an open abdomen in one quarter of the 290 patients with bowel injuries . For the 307 patients without a bowel injury , logistic regression indicated that EN is associated with higher fascial closure rates ( odds ratio [ OR ] , 5.3 ; p < 0.01 ) , decreased complication rates ( OR , 0.46 ; p = 0.02 ) , and decreased mortality ( OR , 0.30 ; p = 0.01 ) . For the 290 patients who experienced a bowel injury , regression analysis showed no significant association between EN  and fascial closure rate ( OR , 0.6 ; p = 0.2 ) , complication rate ( OR , 1.7 ; p = 0.19 ) , or mortality ( OR , 0.79 ; p = 0.69 ) . CONCLUSION EN in the open abdomen after injury is feasible . For patients without a bowel injury , EN in the open abdomen is associated with increased fascial closure rates , decreased complication rates , and decreased mortality .  EN should be initiated in these patients once resuscitation is completed . Although EN for patients with bowel injuries did not seem to affect the outcome in this study , prospect i ve r and omized controlled trials would further clarify the role of EN in this subgroup . LEVEL OF EVIDENCE Therapeutic study , level III BACKGROUND The purpose of this study was to determine the effects of early postoperative tube feeding on outcomes of liver transplant recipients . METHODS Fifty transplant patients were r and omized prospect ively to receive enteral formula via nasointestinal feeding tubes ( tube-feeding [ TF ] group ) or maintenance i.v . fluid until oral diets were initiated ( control group ) . Thirty-one patients completed the study .  Resting energy expenditure , nitrogen balance , and grip strength were measured on days 2 , 4 , 7 , and 12 after liver transplantation . Calorie and protein intakes were calculated for 12 days posttransplant . RESULTS Tube feeding was tolerated in the TF group ( n = 14 ) . The TF patients had greater cumulative 12-day nutrient intakes ( 22,464 + /- 3554 kcal , 927 + /- 122 g protein ) than did the control patients ( 15,474 + /- 5265 kcal , 637 + /- 248 g protein ) ( p < .002 ) . Nitrogen balance was better in the TF group on posttransplant day 4 than in the control group ( p < .03 ) . There was a rise in the overall mean resting energy expenditure in the first two posttransplant weeks from 1487 + /- 338 to 1990 + /- 367 kcal ( p = .0002 ) . Viral infections occurred in 17.7 % of control patients compared with 0 % of TF patients ( p = .05 ) . Although other infections tended to occur more frequently in the control group vs the TF group ( bacterial , 29.4 % vs 14.3 % ; overall infections , 47.1 % vs 21.4 % ) , these differences were not statistically significant . Early posttransplant tube feeding did not influence hospitalization costs , hours on the ventilator , lengths of stay in the intensive care unit and hospital , rehospitalizations , or rejection during the first 21 posttransplant days . CONCLUSIONS Early posttransplant tube feeding was tolerated and promoted improvements in some outcomes and should be considered for all liver transplant patients This document represents the first collaboration between 2 organizations — the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine — to describe best practice s in nutrition therapy in critically ill children . The target of these guidelines is intended to be the pediatric critically ill patient ( > 1 month and 2–3 days in a PICU admitting medical , surgical , and cardiac patients . In total , 2032 citations were scanned for relevance . The PubMed / MEDLINE search result ed in 960 citations for clinical trials and 925 citations for cohort studies . The EMBASE search for clinical trials culled 1661 citations . In total , the search for clinical trials yielded 1107 citations , whereas the cohort search yielded 925 . After careful review , 16 r and omized controlled trials and 37 cohort studies appeared to answer 1 of the 8 preidentified question groups for this guideline . We used the GRADE criteria ( Grading of Recommendations , Assessment 
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EEN reduced infectious complications in unselected critically ill patients , in patients with severe acute pancreatitis , and after GI surgery .
We did not detect any evidence of superiority for early PN or delayed EN  over  EEN .
Conclusions We suggest using EEN in the majority of critically ill under certain pre caution s. In the absence of evidence , we suggest delaying EN  in critically ill patients with uncontrolled shock , uncontrolled hypoxaemia and acidosis , uncontrolled upper GI bleeding , gastric aspirate > 500 ml/6 h , bowel ischaemia , bowel obstruction , abdominal compartment syndrome , and high-output fistula without distal feeding access