Please select the eligibility criteria that correspond to the clinical trial below.
Title: Prospective, Randomized, Multi-Center Trial of Initial Trophic Enteral Feeding Followed by Advancement to Full-Calorie Enteral Feeding vs. Early Advancement to Full-Calorie Enteral Feeding in Patients With Acute Lung Injury (ALI) or Acute Respiratory Distress Syndrome (ARDS) and Prospective, Randomized, Blinded, Placebo-Controlled, Multi-Center Trial of Omega-3 Fatty Acid, Gamma-Linolenic Acid, and Anti-Oxidant Supplementation in the Management of Acute Lung Injury (ALI) or Acute Respiratory Distress Syndrome (ARDS)
Brief Summary: Acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) are medical conditions that occur when there is severe inflammation and increased fluids in both lungs, making it difficult for the lungs to function properly. Hospital treatment for a person with ALI/ARDS often includes the use of a breathing machine, or ventilator, until the person is able to breathe without assistance. Initiating proper nutrition through a feeding tube early in a person's hospital stay may help to improve recovery, but the optimal timing, composition, and amount of feeding treatments are unknown. This study will evaluate whether early or delayed full-calorie feeding through a feeding tube is more effective in reducing recovery time and increasing survival rates in people with ALI/ARDS. The study will also determine whether supplementing the feedings with omega-3 fatty acids and antioxidants benefits people with ALI/ARDS.


Options:
A: Inclusion Criteria:

* Expected ICU stay \> 5 days
* Expected survival \> 7 days
* No contraindication to EN
* Obtained informed consent

Exclusion Criteria:

* Refusal of consent
* Age \< 18 years
* Short bowel syndrome
* Significant persistent gastrointestinal dysfunction with ileus
* High output proximal fistula (\> 1.5 liter/d)
* Patients receiving PN
B: Inclusion Criteria:

* Patients undergone resection of stomach, intestine, or rectum, having the indication of nutrition
* Nutrition risk screening scores around 3
* The age of the patients must be between 18 to 80
* The patients sign the confirmed consent letter
* Weight falls in the range of either 45-56 kg or 60-75 kg

Exclusion Criteria:

* Pregnant or breast feeding
* Contraindication of fluid infusion, acute pulmonary edema, brain edema and functional insufficiency of the heart
* Hypersensitive to the ingredient of the trial product nutrient
* Chemotherapy within 7 days before the beginning of this trial
* Unstable angina pectoris
* Diabetes mellitus
* Disorder of lipid metabolism: triglycerides, cholesterol increased by 1.5 times above the reference value
* Abnormal renal function: serum creatinine or BUN 1.5 times above normal reference value
* Abnormal liver function: ALT or serum total bilirubin 1.5 times above normal reference value
* Having severe drug allergy history and/or asthma
* On operation day, blood loss above 800 ml
* Contraindication to parenteral nutrition
* Receiving regular parenteral nutrition within 7 days before the trial
C: Inclusion Criteria: Patients will be eligible for inclusion in the study if they meet the following criteria:

* Mechanical ventilation expected to last at least 72 hours.
* Presence of, or primary physician's intent to place, an enteral feeding tube and begin enteral feeds.

Exclusion Criteria:

* More than 48 hours elapsed since both inclusion criteria met.
* Patient, legal representative, or physician refuses consent or is unavailable to provide consent.
* Patient, legal representative, or physician not committed to full support (Exception: A patient will not be excluded if he/she would receive all supportive care except for attempts at resuscitation from cardiac arrest).
* Presence of malignant or irreversible condition and estimated 28 day mortality greater than 50%.
* Severe or refractory shock.
* Moribund patients not expected to survive 24 hours from start of enteral feeding (as determined by primary medical team).
* Child-Pugh score greater than 10.
* Presence of partial or complete mechanical bowel obstruction, or ischemia, or infarction.
* Current TPN use or intent to use TPN within 7 days.
* Severe malnutrition with BMI less than 18.5 and/or loss of more than 30% total body weight in the previous 6 months.
* Neuromuscular disease impairing the ability to ventilate spontaneously.
* Laparotomy expected within 7 days.
* Unable to raise head of bed 45°.
* greater than 30% total body surface area burns.
* Absence of GI tract/short bowel syndrome - defined as entire length of small bowel totaling 4 feet or less.
* Presence of high-output (\> 500 cc/day) enterocutaneous fistula.
* Age less than 13 years
* Allergy to enteral formula
D: Inclusion Criteria:

* Must meet the following three criteria at study entry within a 24-hour period: 1) PaO2/FiO2 less than or equal to 300 (if altitude is more than 1000 meters, then PaO2/FiO2 less than or equal to 300 x \[barometric pressure/760\]), 2) bilateral infiltrates (patchy, diffuse, homogeneous, or asymmetric) consistent with pulmonary edema on frontal chest radiograph, and 3) requirement for positive pressure ventilation via endotracheal tube
* No clinical evidence of left-sided cardiac failure to account for bilateral pulmonary infiltrates
* Intention of primary medical team to enterally feed the patient
* Undergoes enteral feeding within 48 hours of meeting inclusion criteria

Exclusion Criteria:

* Neuromuscular disease that impairs ability to breath without assistance, such as cervical spinal cord injury at level C5 or higher, amyotrophic lateral sclerosis, Guillain-Barré syndrome, or myasthenia gravis
* Pregnant or breastfeeding
* Severe chronic respiratory disease. More information about this criterion can be found in the protocol.
* Burns on greater than 40% total body surface area
* Malignancy or other irreversible disease or condition for which 6-month mortality is estimated to be greater than 50%. More information about this criterion can be found in the protocol.
* Allogeneic bone marrow transplant within the 5 years before study entry
* Patient, surrogate, or physician not committed to full support (exception: a patient will not be excluded if he/she would receive all supportive care except for attempts at resuscitation from cardiac arrest)
* Severe chronic liver disease (Child-Pugh score of 11 to 15)
* Diffuse alveolar hemorrhage from vasculitis
* Morbid obesity, defined as 1 kg/cm body weight
* Unwilling or unable to use the ARDS network 6 mL/kg PBW ventilation protocol
* Moribund patient not expected to survive 24 hours
* No intent to obtain central venous access for monitoring intravascular pressures
* More than 72 hours since mechanical ventilation initiated
* Refractory shock. More information about this criterion can be found in the protocol.
* Unable to obtain enteral access
* Presence of partial or complete mechanical bowel obstruction
* Presence of ischemia or infarction
* Current total parenteral nutrition (TPN) use or intent to use TPN within 7 days of study entry
* Severe malnutrition with body mass index less than 18.5 or loss of more than 30% total body weight in the 6 months before study entry
* Laparotomy expected within 7 days of study entry
* Unable to raise head of bed 30 to 45 degrees
* Short-bowel syndrome or absence of gastrointestinal tract
* Presence of high-output (greater than 500 cc/day) enterocutaneous fistula
* International normalized ratio greater than 5.0, platelet count less than 30,000/mm3, or history of bleeding disorder
* Intracranial hemorrhage within the 1 month before study entry
* Allergy to enteral formula, omega-3 fatty acids, GLA, vitamin E, vitamin C, beta-carotene, taurine, or L-carnitine
* Requirement for, or physician insistence on, enteral formula supplemented with omega-3 fatty acids (ex: Oxepa®, Impact®) or providing omega-3 fatty acid, GLA, or antioxidant supplementation

Answer: D