Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Impact of Supplemental Parenteral Nutrition (SPN) on Infection Rate, Duration of Mechanical Ventilation and Rehabilitation in Intensive Care Unit Patients: A Quality Control Program for the Implementing of New Nutrition Guidelines
Brief Summary: Rationale: Enteral nutrition (EN) in the intensive care (ICU) patients is recommended as a standard of care. However, EN alone is often associated with insufficient energy intakes and increased complication rates. Recently the investigators proposed to decrease this deficit by combining EN and supplemental parenteral nutrition (SPN) whenever EN is insufficient (\< 60% of their predicted energy needs) at day 3 after admission in the ICU.

Objective: This study aims at: a/ investigating if the delivery of optimal nutrition support (100 % of predicted energy targets) in ICU patients by the combined administration of SPN and EN optimizes their clinical outcome; b/ implementing the new ICU nutrition guidelines.

Study design: Prospective, controlled, randomized clinical study.

Study site: Service of Intensive Care, Geneva University Hospital.

Patient population: 220 ICU patients to be included: expected length of stay \> 5 days, expected survival \> 7 days, no contraindication to EN, obtained informed consent from themselves or their next of keen.

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.

Nutrition: At day 3 after admission, if energy input is \< 60%; patients are randomized into either the "Control group" (EN alone) or the "SPN group" (EN + PN) to reach 100% of their predicted energy needs. Tight glycaemic control (target 6.0 to 8.3 mmol/l) to be achieved according to our local practice by insulin administration.

Study endpoints:

* Primary: nosocomial infections (CDC criteria)
* Secondary: Mechanical ventilation duration, ICU and hospital length of stay, antibiotic free days, ICU complications (extra-renal epuration, neurological, cardiac and respiratory complications), energy and protein balance, 28 days clinical outcome.


Options:
A: Arm Label: SPN group; Type: EXPERIMENTAL; Interventions: Dietary Supplement: SPN | Arm Label: Control gr; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: DIETARY_SUPPLEMENT; Name: SPN; Assigned to Arm(s): SPN group
B: Arm Label: 1; Type: EXPERIMENTAL; Interventions: Behavioral: Minimal (Trophic) Feeding, Dietary Supplement: Omega-3 Fatty Acids and Antioxidant Supplements | Arm Label: 2; Type: EXPERIMENTAL; Interventions: Behavioral: Full Feeding, Dietary Supplement: Omega-3 Fatty Acids and Antioxidant Supplements | Arm Label: 3; Type: EXPERIMENTAL; Interventions: Behavioral: Minimal (Trophic) Feeding, Dietary Supplement: Placebo | Arm Label: 4; Type: PLACEBO_COMPARATOR; Interventions: Behavioral: Full Feeding, Dietary Supplement: Placebo | Intervention Type: BEHAVIORAL; Name: Minimal (Trophic) Feeding; Assigned to Arm(s): 1, 3 | Intervention Type: BEHAVIORAL; Name: Full Feeding; Assigned to Arm(s): 2, 4 | Intervention Type: DIETARY_SUPPLEMENT; Name: Omega-3 Fatty Acids and Antioxidant Supplements; Assigned to Arm(s): 1, 2 | Intervention Type: DIETARY_SUPPLEMENT; Name: Placebo; Assigned to Arm(s): 3, 4
C: Arm Label: 1; Type: EXPERIMENTAL; Interventions: Behavioral: trophic enteral feeds | Arm Label: 2; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: trophic enteral feeds | Intervention Type: BEHAVIORAL; Name: trophic enteral feeds; Assigned to Arm(s): 1, 2
D: Arm Label: Normocaloric feeding; Type: NO_INTERVENTION; Interventions: Other: Hypocaloric feeding | Intervention Type: OTHER; Name: Hypocaloric feeding; Assigned to Arm(s): Normocaloric feeding

Answer: A