Remarks: This recommendation refers to nonsurgical critically ill patients with sepsis or septic shock.
7. We suggest the use of prokinetic agents in critically ill patients with sepsis or septic shock and feeding intolerance (weak recommendation, low quality of evidence).
8. We suggest placement of postpyloric feeding tubes in critically ill patients with sepsis or septic shock with feeding intolerance or who are considered to be at high risk of aspiration (weak recommendation, low quality of evidence).
9. We recommend against the use of IV selenium to treat sepsis and septic shock (strong recommendation, moderate quality of evidence).
10. We suggest against the use of arginine to treat sepsis and septic shock (weak recommendation, low quality of evidence).
11. We recommend against the use of glutamine to treat sepsis and septic shock (strong recommendation, moderate quality of evidence).
12. We make no recommendation about the use of carnitine for sepsis and septic shock.
U. SETTING GOALS OF CARE
1. We recommend that goals of care and prognosis be discussed with patients and families (BPS).
2. We recommend that goals of care be incorporated into treatment and end-of-life care planning, utilizing palliative care principles where appropriate (strong recommen- dation, moderate quality of evidence).
3. We suggest that goals of care be addressed as early as feasible, but no later than within 72 hours of ICU admission (weak recommendation, low quality of evidence).