Feeding the critically ill patient.

OBJECTIVE: Critically ill patients are usually unable to maintain adequate volitional intake to meet their metabolic demands. As such, provision of nutrition is part of the medical care of these patients. This review provides detail and interpretation of current data on specialized nutrition therapy in critically ill patients, with focus on recently published studies.

DATA SOURCES: The authors used literature searches, personal contact with critical care nutrition experts, and knowledge of unpublished data for this review.

STUDY SELECTION: Published and unpublished nutrition studies, consisting of observational and randomized controlled trials, are reviewed.

DATA EXTRACTION: The authors used consensus to summarize the evidence behind specialized nutrition.

DATA SYNTHESIS: In addition, the authors provide recommendations for nutritional care of the critically ill patient.

CONCLUSIONS: Current evidence suggests that enteral nutrition, started as soon as possible after acute resuscitative efforts, may serve therapeutic roles beyond providing calories and protein. Although many new studies have further advanced our knowledge in this area, the appropriate level of standardization has not yet been achieved for nutrition therapy, as it has in other areas of critical care. Protocolized nutrition therapy should be modified for each institution based on available expertise, local barriers, and existing culture in the ICU to optimize evidence-based nutrition care for each critically ill patient.