Nutrition support protocols and their influence on the delivery of enteral nutrition: a systematic review.

Abstract

Malnutrition remains prevalent in critically ill adults and is associated with poor outcomes and increased cost of hospitalization. To (a) determine whether implementation of a nutrition support protocol improves delivery of nutrients in critically ill patients, and (b) evaluate whether patients receiving nutrition support based on a protocol have better outcomes than those who do not. CINHAL and PUBMED databases were searched utilizing keywords "model," "nutrition," intensive care," "algorithm," "critical care," "protocol," and "feeding guidelines." Selection criteria included original studies published in English with publication date between January 1, 2005, and December 31, 2010; a critically ill adult population; and level 1 or 2 studies. Studies were collected and reviewed by a single reviewer. Data extraction and quality assessment were assured utilizing a standardized form. A narrative description of results was provided due to variability in methods and outcome measures of included studies. Ninety-nine studies emerged and 22 studies were considered for inclusion. Four studies were selected. Use of a nutrition support protocol was found to lead to increased efficacy in the delivery of nutrients via the enteral route. The use of a nutrition support protocol appears to increase the efficacy of enteral nutrition delivery. Further research is needed to determine the effect of increased enteral nutrition adequacy on patient outcomes. The use of an evidenced-based protocol is recommended to improve protein and energy delivery in the critically ill.