175 M1b. Immune-modulating formulations containing arginine and FO should be considered in patients with severe trauma. (Very Low) Traumatic Brain Injury M2a. Similar to other critically ill patients, early enteral feeding should be initiated in the immediate posttrauma period (within 24–48 hours of injury) once the patient is hemodynamically stable. (Very Low) M2b. Either arginine-containing immune-modulating formulations or EPA/DHA supplement with standard enteral formula should be used in patients with TBI. Open Abdomen M3a. Early EN (24–48 hours postinjury) is suggested in patients treated with an OA in the absence of a bowel injury. M3b. Providing an additional 15–30 g of protein per liter of exudate lost for patients with OA is suggested. Energy needs should be determined as for other ICU patients (see section A). Burns M4a. EN should be provided to burn patients whose GI tracts are functional and for whom volitional intake is inadequate to meet estimated energy needs. PN should be reserved for those burn patients for whom EN is not feasible or not tolerated. M4b. IC should be used when available to assess energy needs in burn patients with weekly repeated measures. M4c. Patients with burn injury should receive protein in the range of 1.5–2 g/kg/d. M4d. Very early initiation of EN (if possible, within 4–6 hours of injury) in a patient with burn injury is suggested. N. SEPSIS N1. Critically ill patients should receive EN therapy within 24–48 hours of making the diagnosis of severe sepsis/ septic shock as soon as resuscitation is complete and the patient is hemodynamically stable. N2. Using exclusive PN or supplemental PN in conjunction with EN early in the acute phase of severe sepsis or septic shock is not suggested, regardless of patients’ degree of nutrition risk. (Very Low) N3. Supplementation with selenium, zinc, and antioxidants in sepsis cannot be recommended at this time due to conflicting studies. (Moderate) N4. The provision of trophic feeding (defined as 10–20 kcal/h or up to 500 kcal/d) is suggested for the initial phase of sepsis, advancing as tolerated after 24–48 hours to >80% of target energy goal over the first week. We suggest delivery of 1.2–2 g protein/kg/d. N5. Immune-modulating formulas should not be used routinely in patients with severe sepsis. (Moderate)