Standardization of nutritional support: are protocols useful?
This paper reviews the benefits that a structured format such as a protocol can bring to the delivery of nutritional support. The four main areas of influence are: (1) patient selection, in which indications for feeding and evaluation of the risk/benefit ratio are discussed; (2) timing of nutritional support, in which guidelines for initiating feeding are proposed; (3) delivery of nutrition, in which protocols to limit complications and optimize delivery are reviewed; and (4) feed content, in which guidelines for appropriate nutrients and formulation for special considerations are identified. The importance of an evidence base is stressed and some of the evidence supporting specific recommendations is reviewed.
Adam
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ICU, The Middlesex Hospital, University College London Hospitals Trust, UK. sheila.adam@uclh.org
D000465:Algorithms; D002985:Clinical Protocols / Q000592:standards*; D016638:Critical Illness / Q000628:therapy; D003663:Decision Trees; D004734:Energy Metabolism; D019317:Evidence-Based Medicine; D005526:Food, Formulated / Q000592:standards*; D006801:Humans; D015596:Nutrition Assessment; D018673:Nutrition Policy; D009751:Nutritional Requirements; D018529:Nutritional Support / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000451:nursing / Q000592:standards*; D018579:Patient Selection; D017410:Practice Guidelines as Topic / Q000592:standards*; D013997:Time Factors