Intervention, Randomization and blinding
We enrolled 54 critically ill patients in this study. Patients were randomly assigned using block randomization with fixed block size of 4 to placebo (n=27) or L-Carnitine (LC) group (n=27). The intervention group received 3000 mg/day L-Carnitine divided into 3 equal doses of 1 gram L-carnitine as a liquid form (BSK, Zist Takhmir Co, Tehran-Iran) with daily enteral feeding for 7-days and the placebo group (Distilled water) with same dose and duration. L-carnitine and placebo are same regarding the color, shape, odor and size, thus, patients, and physicians and investigators were blinded. Furthermore, the laboratory personnel and statisticians were blinded to the treatment allocation.
In both groups, after 24-48 hours of admission and when hemodynamic resuscitation and stabilization were carried out, enteral nutrition was initiated to provide 80-100% of the energy requirements of each patient. Energy requirement was calculated to provide 25 kilocalories of energy per kilogram of the body weight of each patient.