173 and FO) become available in the United States, their use should be considered in the critically ill patient who is an appropriate candidate for PN. H4. The use of standardized commercially available PN versus compounded PN admixtures in the ICU patient has no advantage in terms of clinical outcomes. H5. A target blood glucose range of 140 or 150–180 mg/dL is recommended for the general ICU population; ranges for specific patient populations (postcardiovascular surgery, head trauma) may differ and are beyond the scope of this guideline. (Moderate) H6. Parenteral glutamine supplementation should not be used routinely in the critical care setting. (Moderate) H7. As tolerance to EN improves, the amount of PN energy should be reduced and finally discontinued when the patient is receiving >60% of target energy requirements from EN. I. PULMONARY FAILURE I1. Specialty high-fat/low-carbohydrate formulations designed to manipulate the respiratory quotient and reduce CO 2 production should not be used in ICU patients with acute respiratory failure (not to be confused with recommendation E3). (Very Low) I2. Fluid-restricted energy-dense EN formulations should be considered for patients with acute respiratory failure (especially if in a state of volume overload). I3. Serum phosphate concentrations should be monitored closely and phosphate replaced appropriately when needed. J. RENAL FAILURE J1. ICU patients with acute renal failure (ARF) or AKI should be placed on a standard enteral formulation, and standard ICU recommendations for protein (1.2–2 g/kg actual body weight per day) and energy (25–30 kcal/kg/d) provision should be followed. If significant electrolyte abnormalities develop, a specialty formulation designed for renal failure (with appropriate electrolyte profile) may be considered. J2. Patients receiving frequent hemodialysis or CRRT should receive increased protein, up to a maximum of 2.5 g/kg/d. Protein should not be restricted in patients with renal insufficiency as a means to avoid or delay initiating dialysis therapy. (Very Low) K. HEPATIC FAILURE K1. A dry weight or usual weight should be used instead of actual weight in predictive equations to determine energy and protein in patients with cirrhosis and hepatic failure, due to complications of ascites, intravascular volume depletion, edema, portal hypertension, and hypoalbuminemia. Nutrition regimens should avoid restricting protein in patients with liver failure, using the same recommendations as for other critically ill patients (see section C4).