Efficacy and Safety Study of a Low-carbohydrate Tube Feed in Critically Ill Patients Under Insulin Therapy

Inclusion Criteria: * Patients with spontaneous aneurysmal subarachnoid hemorrhage (SAH) defined according to Hunt and Hess scale grade HH5 * Requiring mechanical ventilation in the ICU at the time of enrolment * Enteral nutrition (EN) in the ICU at time of enrolment * If enrolment on day 3 of ICU stay, EN equal to or larger than 80% of total calories in case of supplementary parenteral nutrition (PN) with anticipated 100% EN as of day 4 to 8 of ICU stay * If enrolment on day 4 of ICU stay, 100% EN planned for at least 5 days from the time of enrolment * Patients expected to stay in the ICU for at least 5 days following enrolment * Age 18 - 75 years * Glycemic control with intravenous insulin therapy to maintain a target glucose range between 110 mg/dL and 150 mg/dL (6.1 and 8.3 mmol/l) * Informed consent according to local regulations for decisionally impaired subjects Exclusion Criteria: * Patients with septic shock at time of enrolment * Participation in a clinical trial with any investigational product within 4 weeks before study * Patients requiring a fibre free diet * Total or supplementary parenteral nutrition (\> 20% of total calories) * Known or suspected intolerance or allergy to any component of the study product(s), e.g. galactosemia * Gastrectomy * Postpyloric nutrition * Any clinical condition not allowing enteral nutrition (e.g. emesis, severe reflux, severe diarrhea) * Known severe heart failure (NYHA class 4) * Liver insufficiency / failure (male: ALAT \> 150 U/l; female: ALAT \> 120 U/l) * Acute kidney failure (blood creatinine \> 2.5 mg/dl) * Body Mass Index \< 18 or \> 35 kg/m² * Known or suspicion of drug abuse * Pregnant or breast feeding women * Patients with diabetes mellitus type I Exclusion After Enrolment (Withdrawal of Subjects) * Start of PN with more than 20% of total given energy amount/ day * Insulin infusion stopped unexpectedly for \> 12h for non-nutritional reasons * Discharge from ICU * Intolerable AEs * Major protocol violation * Withdrawal of informed consent * Discontinuation of study treatment for other reasons