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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Flowchart of patients admitted to the ICU and patients included and excluded in the study&#46; Others included the following diagnosis&#58; pancreatitis&#44; liver diseases&#44; gastrointestinal bleeding&#44; gastroenteritis&#44; and previous use of laxatives&#46; ICU indicates intensive care unit&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Current guidelines recommend early normocaloric &#40;80&#8211;100&#37; of daily estimated energy expenditure&#41; enteral nutrition as standard of nutritional care in critically ill patients receiving invasive mechanical ventilation&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1&#44;2</span></a> Although the appropriate caloric and protein intake to be provided to critically ill patients remains unclear&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">3</span></a> recent studies showed that a closer to recommended enteral nutrition intake &#40;also known as full nutrition&#41; given during the early phase of intensive care unit &#40;ICU&#41; stay was associated with a favorable outcome&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">4&#8211;6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">However&#44; in the ICU setting&#44; full enteral nutrition requires large amounts of enteral nutrition &#40;greater than 85<span class="elsevierStyleHsp" style=""></span>mL&#47;h&#41;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">7</span></a> and can induce gastrointestinal dysfunction&#44; expressed by feeding intolerance and&#47;or paralysis of lower gastrointestinal tract&#58; This can be due to different factors&#44; such as mechanical ventilation&#44; use of sedatives&#44; opiates&#44; muscle relaxants and vasopressors&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">8</span></a> Feeding intolerance represents a key factor in the pathogenesis of lower respiratory tract infection&#44; which is favored by the early use of enteral nutrition and the routine use of acid suppressive drugs to prevent gastric hemorrhage by increasing gastric pH and promoting bacterial overgrowth&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">7&#8211;12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The exact role of normocaloric enteral nutrition in acquired infections remains controversial&#46; Whilst a recent study found a direct relationship between the volume of enteral nutrition and the lower respiratory tract infection&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">13</span></a> a recently published meta-analysis demonstrated no difference in the risk of acquired infections between patients receiving normocaloric or hypocaloric enteral nutrition&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">14</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Therefore&#44; the aim of this study was to evaluate the effect of the volume and caloric intake of enteral nutrition given&#44; the gastrointestinal function and the type of acid suppressive drug on the incidence of lower respiratory tract infection in critically ill patients with mechanical ventilation&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Patients</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was a retrospective secondary analysis of a previously published study that recorded the volume of enteral nutrition given and evaluated the gastrointestinal function in critically ill patients with mechanical ventilation&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">15</span></a> The study was conducted in a mixed adult ICU from October 2012 to September 2013&#46; For the current study&#44; we specifically recorded in these patients the episodes of lower respiratory tract infection that occurred more than 48<span class="elsevierStyleHsp" style=""></span>h after initiating mechanical ventilation until day 28 post-ICU admission&#46; Patients 18 years of age or older were eligible for enrolment in the study if they were expected to need mechanical ventilation for more than 4 days and if they were receiving enteral nutrition by nasogastric tube within 24<span class="elsevierStyleHsp" style=""></span>h of starting mechanical ventilation&#46; Patients were therefore excluded if they did not tolerate enteral nutrition&#46; Patients were ineligible if they had recent bowel surgery or any abdominal disease&#46; The Institutional Research Committee of our hospital approved the current study and waived the need to obtain specific informed consent due to the retrospective and observational nature of this secondary analysis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Patient management</span><p id="par0030" class="elsevierStylePara elsevierViewall">All patients receiving mechanical ventilation were treated with a continuous intravenous infusion of morphine &#40;0&#46;01&#8211;0&#46;15<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;h&#41; for analgesia and&#47;or midazolam &#40;0&#46;01&#8211;0&#46;15<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;h&#41; or propofol &#40;1&#8211;2<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;h&#41; for sedative purposes&#46; Muscle relaxants were used as required&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Caloric requirements and type of enteral feeding formula or a combination of enteral and parenteral nutrition was left to attending physician criteria&#46; Enteral feedings were started within the first 24<span class="elsevierStyleHsp" style=""></span>h after admission and delivered continuously at a constant rate by an infusion pump&#46; Enteral nutrition products without fiber consisted of polymeric formulas containing 1&#8211;1&#46;25<span class="elsevierStyleHsp" style=""></span>kcal&#47;mL of energy &#40;approximately 20&#37; of proteins&#44; 30&#37; of lipids&#44; and 50&#37; of carbohydrates&#41;&#46; Full feeding rates were calculated with goals of 25&#8211;35<span class="elsevierStyleHsp" style=""></span>kcal&#47;kg per day and 1&#46;2&#8211;1&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;kg per day of protein&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">16</span></a> Blood glucose control was accomplished using institution specific insulin protocols targeting ranges from 80 to 150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; Additional 100<span class="elsevierStyleHsp" style=""></span>mL of water each 6<span class="elsevierStyleHsp" style=""></span>h were administered through nasogastric tube with a syringe to prevent obstruction of the nasogastric tube&#46; All patients received acid suppressive drugs to prevent gastric hemorrhage with histamine-2 receptor antagonists or proton pump inhibitors&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The management of absent or decreased peristalsis and feeding intolerance was performed by the physician in charge aiming to maintain or restore gastrointestinal function by using prokinetics &#40;erythromycin 250<span class="elsevierStyleHsp" style=""></span>mg and&#47;or metoclopramide 10<span class="elsevierStyleHsp" style=""></span>mg every 6&#8211;8<span class="elsevierStyleHsp" style=""></span>h&#44; intravenously&#41;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">17&#8211;19</span></a> or modifying the volume of enteral nutrition&#46; In patients who did not tolerate enteral feeding&#44; supplementary parenteral nutrition was administered temporarily&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a> The protocol of management of the paralysis of lower gastrointestinal tract was published elsewhere&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">15</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Measures taken to prevent the infection of the lower respiratory tract included&#58; strict hand hygiene and training in the airway management&#44; semirecumbent positioning whenever possible&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">20</span></a> preferred use of thin nasogastric tubes&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">21</span></a> control and maintenance of cuff pressure each 8<span class="elsevierStyleHsp" style=""></span>h performed with a manual manometer &#40;Smiths Medical&#44; Portex<span class="elsevierStyleSup">&#174;</span>&#44; Germany&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">7&#44;10</span></a> oral hygiene with aqueous chlorhexidine solutions 0&#46;2&#37; performed every 8<span class="elsevierStyleHsp" style=""></span>h&#44; and short 48&#8211;72<span class="elsevierStyleHsp" style=""></span>h course of intravenous antibiotics in patients with decreased level of consciousness&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">22</span></a> Infection antibiotic management was performed according to local lower respiratory tract infection based on international guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">23</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Definitions</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Lower respiratory tract infections</span><p id="par0050" class="elsevierStylePara elsevierViewall">Lower respiratory tract infections&#44; including ventilator-associated pneumonia &#40;VAP&#41; and ventilator-associated tracheobronchitis &#40;VAT&#41; were defined as infection occurred more than 48<span class="elsevierStyleHsp" style=""></span>h after initiating mechanical ventilation until day 28&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">VAP was defined by the presence of new or progressive radiographic infiltrates associated with at least two of the following criteria&#58; &#40;a&#41; temperature &#62;38&#46;5<span class="elsevierStyleHsp" style=""></span>&#176;C or &#60;36&#46;5<span class="elsevierStyleHsp" style=""></span>&#176;C&#59; &#40;b&#41; leukocyte count &#62;12&#44;000&#47;&#956;L or &#60;4000&#47;&#956;L&#44; and &#40;c&#41; purulent endotracheal aspirate and positive endotracheal aspirate &#40;&#8805;10<span class="elsevierStyleSup">5</span><span class="elsevierStyleHsp" style=""></span>CFU&#47;mL&#41; or bronchoalveolar lavage &#40;&#8805;10<span class="elsevierStyleSup">4</span><span class="elsevierStyleHsp" style=""></span>CFU&#47;mL&#41; cultures&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">24</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">VAT was defined using all the following criteria&#58; fever &#40;&#62;38<span class="elsevierStyleHsp" style=""></span>&#176;C&#41; with no other recognizable cause&#44; purulent sputum production&#44; positive endotracheal aspirate culture &#40;&#8805;10<span class="elsevierStyleSup">5</span><span class="elsevierStyleHsp" style=""></span>CFU&#47;mL&#41; or from bronchoalveolar lavage fluid &#40;&#8805;10<span class="elsevierStyleSup">4</span><span class="elsevierStyleHsp" style=""></span>CFU&#47;mL&#41;&#44; and no radiographic signs of new pneumonia&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">24&#44;25</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Gastrointestinal dysfunction</span><p id="par0065" class="elsevierStylePara elsevierViewall">For the purpose of the study&#44; gastrointestinal dysfunction included feeding intolerance and paralysis of lower gastrointestinal tract&#46; Feeding intolerance is a general term indicating intolerance of enteral feeding for whatever clinical reason &#40;vomiting&#44; gastroesophageal reflux or high gastric residuals volume greater than 500<span class="elsevierStyleHsp" style=""></span>mL&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">26</span></a> Paralysis of lower gastrointestinal tract was the inability of the bowel to pass stool due to impaired peristalsis&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">17</span></a> Clinical signs included absence of stool for more than 3 consecutive days without mechanical obstruction&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">17</span></a> We considered as having paralysis of lower gastrointestinal tract all patients treated with laxatives&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Study endpoints</span><p id="par0070" class="elsevierStylePara elsevierViewall">The primary endpoint was the association between the volume of enteral nutrition intake and the occurrence of lower respiratory tract infection &#40;VAP and VAT&#41; that occurred more than 48<span class="elsevierStyleHsp" style=""></span>h after initiating mechanical ventilation until day 28&#46; According to the primary objective&#44; patients were classified in&#58; infected group&#44; patients who had a first lower respiratory tract infection in the above mentioned period&#44; and the uninfected group&#44; patients who did not have lower respiratory tract infection in this period&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Secondary endpoints analyzed the association between gastrointestinal dysfunction and the type of acid suppressive therapy with the incidence of lower tract infection&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Data collection</span><p id="par0080" class="elsevierStylePara elsevierViewall">We collected demographic characteristics&#44; including age&#44; gender and weight&#46; Severity of illness was evaluated by the Acute Physiology and Chronic Health Evaluation &#40;APACHE&#41; II score&#44; the Simplified Acute Physiology Score &#40;SAPS&#41; II&#44; and the Sepsis-related Organ Failure Assessment &#40;SOFA&#41; score&#44; calculated after the first 24<span class="elsevierStyleHsp" style=""></span>h of ICU stay&#46; Comorbidities were evaluated by the Charlson index&#46; Reason for mechanical ventilation was noted&#46; Pharmacological treatment associated with gastrointestinal dysfunction&#44; such as prokinetic agents&#44; laxative&#44; and opiates up to 10 days of start mechanical ventilation was collected&#44; as well as the type of acid suppressive therapy &#40;histamine-2 receptor antagonist or proton pump inhibitor&#41;&#46; Nutrition characteristics included daily enteral and parenteral nutrition routes&#46; Enteral intake was collected until ICU discharge or death&#44; or up to 10 days of initiating mechanical ventilation&#46; The average daily energy intake was calculated by dividing the cumulative energy intake during ICU stay for up to 10 days by the number of ICU days with enteral intake&#46; The average daily protein intake was calculated in the same manner&#46; Episodes of lower respiratory tract infection that occurred more than 48<span class="elsevierStyleHsp" style=""></span>h after initiating mechanical ventilation until day 28 were collected&#46; Length of mechanical ventilation&#44; ICU and in-hospital length of stay&#44; and ICU and in-hospital mortality were recorded&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Statistical analysis</span><p id="par0085" class="elsevierStylePara elsevierViewall">Variable summaries were shown as frequency&#44; proportion&#44; mean &#40;SD&#41;&#44; or median &#40;IQR&#41; as appropriate&#46; Descriptive analyses were performed by using the <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> or Fisher&#39;s exact tests for categorical variables&#44; and the Student&#39;s <span class="elsevierStyleItalic">t</span> test or Mann&#8211;Whitney&#8211;Wilcoxon test for continuous variables as appropriate&#46; To determine the occurrence of lower respiratory tract infection that occurred more than 48<span class="elsevierStyleHsp" style=""></span>h after initiating mechanical ventilation until day 28 &#40;dependent variable&#41; in relation to gastrointestinal dysfunction &#40;independent variable&#41;&#44; we used Cox proportional hazards ratios in univariate and adjusted multivariable models&#46; We selected variables for the adjusted multivariable analysis if their <span class="elsevierStyleItalic">p</span> value was 0&#46;20 or lower in the univariate analysis and according to their clinical relevance&#46; We generated survival analysis curves during 28-day follow-up using the Kaplan&#8211;Meier method and log-rank test to compare the association of different variables with lower respiratory tract infection&#46; Patients who died during 28 days follow-up were censored&#46; All statistical tests were 2-sided&#46; A <span class="elsevierStyleItalic">p</span> value of &#60;0&#46;05 was considered statistically significant&#46; Data were analyzed using the SPSS statistical package&#44; version 19&#46;0 &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#41;&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Results</span><p id="par0090" class="elsevierStylePara elsevierViewall">Of 588 patients admitted to the ICU during the study period&#44; 197 patients were eligible and 12 were excluded from the analysis due to missing data&#44; leaving 185 patients &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Sixty-six out of 185 patients &#40;35&#46;7&#37;&#41; had lower respiratory tract infection&#44; 27 patients had VAP and 39 VAT&#46; Nine out of 66 patients &#40;13&#46;6&#37;&#41; had a second episode of lower respiratory tract infection &#40;4 patients VAP and 5 VAT&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">At baseline&#44; the uninfected and infected groups were similar with respect to demographic characteristics&#44; the severity of illness evaluated by SAPS II&#44; APACHE II and SOFA&#44; and the time between ICU admission and start of mechanical ventilation &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Infected group had lower Charlson comorbidity index than the uninfected group &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The probability of a first lower respiratory tract infection more than 48<span class="elsevierStyleHsp" style=""></span>h after initiating mechanical ventilation until day 28 was significantly higher in neurological patients than in the other patients &#91;49 of 95 patients &#40;51&#46;6&#37;&#41; <span class="elsevierStyleItalic">vs</span>&#46; 17 of 90 patients &#40;18&#46;9&#37;&#41;&#44; respectively&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#93; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The first episode of lower respiratory tract infection was detected at a mean time of 7&#46;7 &#40;5&#46;2&#41; days and a median of 7 &#40;4&#8211;9&#41; days&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Bacteria most frequently isolated from respiratory samples were gram negative in 29 &#40;43&#46;9&#37;&#41; patients and gram positive in 11 &#40;16&#46;7&#37;&#41; patients&#46; Polymicrobial infection was found in 21 &#40;31&#46;8&#37;&#41; patients and in 5 patients the diagnosis of VAP was done although negative cultures were obtained&#46; Taking into account the polymicrobial infection in 21 patients&#44; the most common microorganisms isolated were&#58; <span class="elsevierStyleItalic">Staphylococcus aureus</span> &#40;18 episodes&#41;&#44; <span class="elsevierStyleItalic">Pseudomona aeruginosa</span> &#40;11 episodes&#41;&#44; <span class="elsevierStyleItalic">Escherichia coli</span> &#40;10 episodes&#41;&#44; <span class="elsevierStyleItalic">Enterobacter cloacae</span> &#40;9 episodes&#41;&#44; <span class="elsevierStyleItalic">Enterobacter aerogenes</span> &#40;7 episodes&#41;&#44; <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> &#40;7 episodes&#41;&#44; <span class="elsevierStyleItalic">Serratia marcescens</span> &#40;4 episodes&#41;&#44; <span class="elsevierStyleItalic">Citrobacter</span> &#40;4 episodes&#41;&#44; <span class="elsevierStyleItalic">Stenotrophomonas maltophilia</span> &#40;3 episodes&#41; and others &#40;9 episodes&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The uninfected and infected groups were similar in the volume of enteral nutrition and caloric intake &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; frequency and days of interrupted enteral nutrition and supplemental parenteral nutrition&#44; type of acid suppressive therapy and percentage of patients with continuous opiate perfusion therapy &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Median days of prokinetic agents&#44; laxative polyethylene glycol&#44; and opiates therapy were significantly higher in the infected group &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">The Cox proportional hazards model found that the reason for mechanical ventilation &#40;neurologic failure <span class="elsevierStyleItalic">vs&#46;</span> others&#41; was the only independent variable related to lower respiratory tract infection &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Others variables entered in the Cox hazard model&#44; including the volume of enteral nutrition&#44; type of acid suppressive therapy&#44; prokinetic agents&#44; laxative polyethylene glycol&#44; and opiates were not significantly related to lower respiratory tract infection that occurred more than 48<span class="elsevierStyleHsp" style=""></span>h after initiating mechanical ventilation until day 28 &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">The Kaplan&#8211;Meier curves showed no differences in the time to present lower respiratory tract infection by the volume of enteral nutrition evaluated in intertertiles &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;23 by the log-rank test&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Mean &#40;SD&#41; values and ranges of intertertiles of enteral nutrition volume were&#58; first 41 &#40;9&#41; &#40;6-51&#41; mL&#47;h&#44; second 56 &#40;2&#41; &#40;51-59&#41; mL&#47;h&#44; and third 64 &#40;5&#41; &#40;59-78&#41; mL&#47;h&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">The infected group had higher duration of mechanical ventilation and ICU and in-hospital length of stay&#46; No differences were found in ICU and in-hospital mortality &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">The main result of our study was we found no association between the volume of enteral nutrition given and the incidence of lower respiratory tract infection in patients with mechanical ventilation&#46; In addition&#44; nor the presence of gastrointestinal dysfunction neither the type of acid suppressive therapy were associated with lower respiratory tract infection&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Our results are in consonance with the meta-analysis of Marik and Hooper&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">14</span></a> who found no difference in the risk of acquired infections between patients receiving intentional hypocaloric as compared to normocaloric nutritional goals&#46; The existence of gastrointestinal dysfunction and the type of acid suppressive therapy used were not associated with lower respiratory tract infection&#44; being the neurological failure as a reason for mechanical ventilation the only independent risk factor for lower respiratory tract infection&#44; a well-known phenomenon in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">27&#8211;29</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Our main findings are in disagreement with the recent study by Chung et al&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">13</span></a> This could be due&#44; in part&#44; to differences in the study design &#40;they included patients without enteral nutrition&#41;&#44; in the pathology of patients &#40;they included patients with severe abdominal injury&#41;&#44; and in the number of patients &#40;they included a higher number of patients&#41;&#46; Another factors could potentially had an influence&#44; such as the measures implemented to prevent regurgitation and aspiration as semirecumbent positioning&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">20</span></a> preferred use of thin nasogastric tubes <a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">21</span></a> and routine care of monitoring tracheal cuff pressure every 8<span class="elsevierStyleHsp" style=""></span>h&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">30&#44;31</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Undernutrition seems common in critically ill patients&#44; as shown by a recent study including more than 200<span class="elsevierStyleHsp" style=""></span>ICUs&#44; reporting a mean caloric intake of 14&#46;5<span class="elsevierStyleHsp" style=""></span>kcal&#47;kg&#47;d&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">32</span></a> Our mean caloric intake was 19&#46;5<span class="elsevierStyleHsp" style=""></span>kcal&#47;kg&#47;d&#44; lower than the 25&#8211;35<span class="elsevierStyleHsp" style=""></span>kcal&#47;kg&#47;d necessary to achieve a full nutrition&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">5&#44;16&#44;33</span></a> Thus&#44; we cannot definitively answer whether the intake of full nutrition by enteral route could increase feeding intolerance and the incidence of lower respiratory tract infections&#46; Anyway&#44; this highlights that other strategies would be necessary to minimize undernutrition in critically ill patients&#44; such as using supplemental parenteral nutrition&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Assessing gastrointestinal dysfunction in patients with mechanical ventilation is difficult&#44; due to the lack of agreement on the definition and&#44; in our case&#44; because of the observational and retrospective nature of the study in which the management was performed by the physician in charge&#46; To assess feeding intolerance we did not monitor the residual gastric volume because it has been proved ineffective in preventing the development of VAP&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">7&#44;34</span></a> In addition&#44; residual gastric volume monitoring leads to unnecessary interruptions of enteral nutrition delivery with subsequent inadequate feeding&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">11</span></a> Therefore&#44; we evaluated gastrointestinal dysfunction by the days of treatments with prokinetic agents and polyethylene glycol laxative&#46; The median days of prokinetic agents and laxative polyethylene glycol were significantly higher in the infected group than in the uninfected group&#44; suggesting a potential association between gastrointestinal dysfunction and lower respiratory tract infection&#46; Therefore&#44; and even though it was not confirmed by our multivariate analysis&#44; more studies are required to rule out this possibility&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">We found no differences in the incidence of lower respiratory tract infection among patients receiving proton pump inhibitor and those treated with histamine-2 receptor antagonists&#46; The acid suppressive drugs to prevent gastric hemorrhage could increase susceptibility to lower respiratory tract infection because these drugs increase gastric pH&#44; thus allowing bacterial colonization&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">35</span></a> Controversy remains regarding the optimal regimen to use when prophylaxis against stress-related gastric hemorrhage is indicated&#46;<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">36&#44;37</span></a> A recent large observational study showed that the use of proton pump inhibitor increased the risk of VAP more than histamine-2 receptor antagonist&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">38</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">We acknowledged several limitations&#58; first&#44; this is a retrospective secondary analysis of a previously published study recording gastrointestinal function in critically ill patients with mechanical ventilation&#46; Second&#44; the volume of enteral nutrition intake&#44; the management of feeding intolerance and the decision of initiating supplementary parenteral nutrition was performed by the physician in charge the patient&#46; However&#44; we believe that this reflects daily clinical practice&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In conclusion&#44; the volume of enteral nutrition&#44; the caloric intake&#44; the existence of gastrointestinal dysfunction and the type of acid suppressive therapy were not associated to lower respiratory tract infection in critically ill patients with mechanical ventilation&#46; The neurologic reason for mechanical ventilation was associated to lower respiratory tract infection&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Funding</span><p id="par0180" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Authors&#8217; contribution</span><p id="par0185" class="elsevierStylePara elsevierViewall">Asunci&#243;n Colomar&#58; data collection&#44; manuscript preparation and manuscript review&#46; Bego&#241;a Guardiola&#58; data collection&#44; manuscript preparation and manuscript review&#46; Juan A&#46; Llompart-Pou&#58; manuscript preparation and manuscript review&#46; Ignacio Ayestar&#225;n&#58; data collection&#44; manuscript preparation and manuscript review&#46; Javier Rodr&#237;guez-Pilar&#58; data collection and manuscript review&#46; Mireia Ferreruela&#58; data collection and manuscript review&#46; Joan M&#46; Raurich&#58; literature search&#44; data collection&#44; study design&#44; data analysis&#44; manuscript preparation&#44; manuscript review&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Conflict of interest</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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          "titulo" => "Patients and methods"
          "secciones" => array:6 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Patients"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Patient management"
            ]
            2 => array:3 [
              "identificador" => "sec0025"
              "titulo" => "Definitions"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0030"
                  "titulo" => "Lower respiratory tract infections"
                ]
                1 => array:2 [
                  "identificador" => "sec0035"
                  "titulo" => "Gastrointestinal dysfunction"
                ]
              ]
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            3 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Study endpoints"
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            4 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Data collection"
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            5 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Statistical analysis"
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          "identificador" => "sec0055"
          "titulo" => "Results"
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        7 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Discussion"
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        8 => array:2 [
          "identificador" => "sec0085"
          "titulo" => "Funding"
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        9 => array:2 [
          "identificador" => "sec0090"
          "titulo" => "Authors&#8217; contribution"
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        10 => array:2 [
          "identificador" => "sec0095"
          "titulo" => "Conflict of interest"
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        11 => array:1 [
          "titulo" => "References"
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    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-06-15"
    "fechaAceptado" => "2016-09-27"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec859714"
          "palabras" => array:5 [
            0 => "Enteral nutrition"
            1 => "Mechanical ventilation"
            2 => "Ventilator-associated pneumonia"
            3 => "Gastrointestinal tract"
            4 => "Proton pump inhibitors"
          ]
        ]
      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec859713"
          "palabras" => array:5 [
            0 => "Nutrici&#243;n enteral"
            1 => "Ventilaci&#243;n mec&#225;nica"
            2 => "Neumon&#237;a asociada a ventilaci&#243;n mec&#225;nica"
            3 => "Tracto gastrointestinal"
            4 => "Inhibidores de la bomba de protones"
          ]
        ]
      ]
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    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the effect of enteral nutrition volume&#44; gastrointestinal function and the type of acid suppressive drug upon the incidence of lower respiratory tract infections in critically ill patients on mechanical ventilation &#40;MV&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective secondary analysis was carried out&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Setting</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The Intensive Care Unit of a University Hospital&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Patients or participants</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Patients<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>18-years-old expected to need MV for more than four days&#44; and receiving enteral nutrition by nasogastric tube within 24<span class="elsevierStyleHsp" style=""></span>h of starting MV&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Interventions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We correlated enteral nutrition volume administered during the first 10 days&#44; gastrointestinal function and the type of acid suppressive therapy with the episodes of lower respiratory tract infection up until day 28&#46; Cox proportional hazards ratios in univariate and adjusted multivariate models were used&#46; Statistical significance was considered for <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Main variables of interest</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Lower respiratory tract infection episodes&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Sixty-six out of 185 patients &#40;35&#46;7&#37;&#41; had infection&#59; 27 patients had ventilator-associated pneumonia&#59; and 39 presented ventilator-associated tracheobronchitis&#46; Uninfected and infected groups were similar in terms of enteral nutrition volume &#40;54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12 and 54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9<span class="elsevierStyleHsp" style=""></span>mL&#47;h&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;94&#41; and caloric intake &#40;19&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;9 and 19&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;2<span class="elsevierStyleHsp" style=""></span>kcal&#47;kg&#47;d&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;81&#41;&#46; The Cox proportional hazards model showed neurological indication of MV to be the only independent variable related to infection &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Enteral nutrition volume&#44; the type of acid suppressive therapy&#44; and the use of prokinetic agents were not significantly correlated to infection&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Enteral nutrition volume and caloric intake&#44; gastrointestinal dysfunction and the type of acid suppressive therapy used were not associated to lower respiratory tract infection in patients on MV&#46;</p></span>"
        "secciones" => array:8 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Design"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Setting"
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          3 => array:2 [
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            "identificador" => "abst0030"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objetivo</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Valorar el efecto del volumen de nutrici&#243;n enteral&#44; la funci&#243;n gastrointestinal y el tipo de protecci&#243;n g&#225;strica en la incidencia de infecci&#243;n respiratoria del tracto inferior en pacientes cr&#237;ticos con ventilaci&#243;n mec&#225;nica &#40;VM&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Dise&#241;o</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis secundario retrospectivo&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">&#193;mbito</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La Unidad de Cuidados Intensivos de un hospital universitario&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes o participantes</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Pacientes con edad<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os que se espera que precisen de VM durante<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>4 d&#237;as y reciban nutrici&#243;n enteral en las primeras 24<span class="elsevierStyleHsp" style=""></span>h&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Intervenciones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Correlacionamos el volumen de nutrici&#243;n enteral administrado durante los primeros 10 d&#237;as&#44; la funci&#243;n gastrointestinal y el tipo de protecci&#243;n g&#225;strica con los episodios de infecci&#243;n pulmonar del tracto inferior hasta el d&#237;a 28&#46; Utilizamos el modelo de regresi&#243;n de Cox&#46; Un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 fue considerado estad&#237;sticamente significativo&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Principal variable de inter&#233;s</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Episodios de infecci&#243;n del tracto respiratorio inferior&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Sesenta y seis de los 185 pacientes &#40;35&#44;7&#37;&#41; presentaron infecci&#243;n&#44; 27 pacientes neumon&#237;a y 39&#160;traqueobronquitis&#46; Los pacientes no infectados e infectados fueron similares en el volumen de nutrici&#243;n enteral &#40;54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12 y 54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9<span class="elsevierStyleHsp" style=""></span>mL&#47;h&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;94&#41; y aporte cal&#243;rico &#40;19&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;9 y 19&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;2<span class="elsevierStyleHsp" style=""></span>kcal&#47;kg&#47;d&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;81&#41;&#46; El modelo de regresi&#243;n de Cox mostr&#243; que la causa neurol&#243;gica de VM fue la &#250;nica variable independiente asociada con infecci&#243;n &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; El volumen de nutrici&#243;n enteral&#44; el tipo de protecci&#243;n g&#225;strica y la funci&#243;n gastrointestinal no se correlacionaron significativamente con la infecci&#243;n&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">El volumen y aporte cal&#243;rico de nutrici&#243;n enteral&#44; la disfunci&#243;n gastrointestinal y el tipo de protecci&#243;n g&#225;strica no se asociaron a la infecci&#243;n del tracto respiratorio inferior en pacientes con VM&#46;</p></span>"
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            "titulo" => "Dise&#241;o"
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          2 => array:2 [
            "identificador" => "abst0055"
            "titulo" => "&#193;mbito"
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          3 => array:2 [
            "identificador" => "abst0060"
            "titulo" => "Pacientes o participantes"
          ]
          4 => array:2 [
            "identificador" => "abst0065"
            "titulo" => "Intervenciones"
          ]
          5 => array:2 [
            "identificador" => "abst0070"
            "titulo" => "Principal variable de inter&#233;s"
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          6 => array:2 [
            "identificador" => "abst0075"
            "titulo" => "Resultados"
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          7 => array:2 [
            "identificador" => "abst0080"
            "titulo" => "Conclusiones"
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Flowchart of patients admitted to the ICU and patients included and excluded in the study&#46; Others included the following diagnosis&#58; pancreatitis&#44; liver diseases&#44; gastrointestinal bleeding&#44; gastroenteritis&#44; and previous use of laxatives&#46; ICU indicates intensive care unit&#46;</p>"
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Daily enteral nutrition volume &#40;in mL&#47;h&#41; and daily caloric intake &#40;in kcal&#47;kg&#47;d&#41; given to uninfected &#40;solid line&#41; and infected &#40;dash line&#41; patients&#44; up to 10 days after ICU admission&#46; Numbers up of the figure represent the patients uninfected and infected for each day&#46;</p>"
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          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier curves show time to lower respiratory tract infection according to the amount of enteral nutrition volume given in intertertiles &#40;first solid line&#44; second dot line&#44; and third dashed line&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">SD&#44; standard deviation&#59; IRQ&#44; interquartile range&#59; APACHE&#44; Acute Physiology and Chronic Health Evaluation&#59; SAPS II&#44; Simplified Acute Physiology Score&#59; SOFA&#44; Sequential Organ Failure Assessment&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Uninfected &#40;<span class="elsevierStyleItalic">n</span>&#58; 119&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Infected &#40;<span class="elsevierStyleItalic">n</span>&#58; 66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Female gender&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;36&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age&#44; years&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Body weight&#44; kg&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Charlson comorbidity index&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">APACHE II score&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">SAPS II score&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">SOFA score&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;4 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;8 &#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Reason for mechanical ventilation&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Neurologic failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46 &#40;38&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49 &#40;74&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Respiratory failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;32&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;10&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Severe sepsis&#47;Septic shock&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;11&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiac failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;4&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;12&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;12&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Time to mechanical ventilation&#44; days&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">SD&#44; standard deviation&#59; IRQ&#44; interquartile range&#59; EN&#44; enteral nutrition&#59; PEG&#44; polyethylene glycol&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Uninfected &#40;<span class="elsevierStyleItalic">n</span>&#58; 119&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Infected &#40;<span class="elsevierStyleItalic">n</span>&#58; 66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Enteral nutrition&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">119 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Enteral nutrition&#44; days&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Volume of enteral nutrition&#44; mL&#47;h</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Enteral caloric intake&#44; kcal&#47;d&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1455 &#40;312&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1442 &#40;234&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Enteral caloric intake&#44; kcal&#47;kg&#47;d&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;4 &#40;4&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;6 &#40;5&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Enteral protein intake&#44; g&#47;d&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Enteral protein intake&#44; g&#47;kg&#47;d&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1 &#40;0&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1 &#40;0&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Interrupted EN&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;21&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;25&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Interrupted EN&#44; days&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;1&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Parenteral nutrition&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Parenteral nutrition&#44; days&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Acid suppressive therapy&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Histamine-2 receptor antagonist&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;36&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;43&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Proton pump inhibitor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76 &#40;63&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;56&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Prokinetic agents&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;32&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;42&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Prokinetic agents&#44; days&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Laxative PEG&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81 &#40;68&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;71&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Laxative PEG&#44; days&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Opiates&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">102 &#40;85&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;92&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Opiates&#44; days&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Univariate analysis</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Multivariate analysis</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Reason for mechanical ventilation &#40;neurologic <span class="elsevierStyleItalic">vs&#46;</span> others&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;79 &#40;2&#46;00&#8211;16&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Enteral nutrition &#40;1<span class="elsevierStyleHsp" style=""></span>mL&#47;h increase&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0 &#40;0&#46;98&#8211;1&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Histamine-2 receptor antagonist <span class="elsevierStyleItalic">vs</span>&#46; proton pump inhibitor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;35 &#40;0&#46;83&#8211;2&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:38 [
            0 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient&#58; Society of Critical Care Medicine &#40;SCCM&#41; and American Society for Parenteral and Enteral Nutrition &#40;A&#46;S&#46;P&#46;E&#46;N&#46;&#41;"
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                          "etal" => true
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                            0 => "S&#46;A&#46; McClave"
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                            2 => "R&#46;G&#46; Martindale"
                            3 => "M&#46;M&#46; Warren"
                            4 => "C&#46; Johnson Braunschweig"
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Parenter Enteral Nutr"
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                        "volumen" => "40"
                        "paginaInicial" => "159"
                        "paginaFinal" => "211"
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              "identificador" => "bib0200"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition &#40;SEMICYUC-SENPE&#41;&#46; Guidelines for specialized nutritional and metabolic support in the critically-ill patient&#46; Update&#46; Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition &#40;SEMICYUC-SENPE&#41;&#58; introduction and methodology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Mesejo"
                            1 => "C&#46; Vaquerizo Alonso"
                            2 => "J&#46; Acosta Escribano"
                            3 => "C&#46; Ortiz Leyba"
                            4 => "J&#46;C&#46; Montejo Gonz&#225;lez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2011"
                        "volumen" => "35S"
                        "paginaInicial" => "1"
                        "paginaFinal" => "6"
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                ]
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            2 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calorie intake of enteral nutrition and clinical outcomes in acutely critically ill patients&#58; a meta-analysis of randomized controlled trials"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46;Y&#46; Choi"
                            1 => "D&#46;A&#46; Park"
                            2 => "J&#46; Park"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Parenter Enteral Nutr"
                        "fecha" => "2015"
                        "volumen" => "39"
                        "paginaInicial" => "291"
                        "paginaFinal" => "300"
                      ]
                    ]
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            3 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The relationship between nutritional intake and clinical outcomes in critically ill patients&#58; results of an international multicenter observational study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Alberda"
                            1 => "L&#46; Gramlich"
                            2 => "N&#46; Jones"
                            3 => "K&#46; Jeejeebhoy"
                            4 => "A&#46;G&#46; Day"
                            5 => "R&#46; Dhaliwal"
                          ]
                        ]
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                    0 => array:2 [
                      "doi" => "10.1007/s00134-009-1567-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2009"
                        "volumen" => "35"
                        "paginaInicial" => "1728"
                        "paginaFinal" => "1737"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19572118"
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