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What is the right amount of nutrition for a critically ill patient? Two randomized, controlled trials demonstrated that higher-rate enteral nutrition was not necessarily better than low-rate enteral feeds (CMAJ 2004; 170:197 and JAMA 2008; 300:2731). With these results in mind, investigators in Saudi Arabia and Canada evaluated the potential benefit of permissive underfeeding (i.e., restricted nonprotein calories but preserved protein intake) in 894 predominantly medical intensive care unit (ICU) patients at seven tertiary medical centers. Patients' average body-mass index was 29 kg/m2.
Patients were randomized to permissive underfeeding or standard feeding. Patients who received high-dose vasopressors or parenteral nutrition were excluded. …