title: Enteral nutrition therapy for critically ill adult patients; critical review and algorithm creation.
abstract: BACKGROUND
  Undernutrition directly affects critically ill patient's clinical outcome and mortality rates.
  
  
  OBJECTIVE
  Interdisciplinar algorithm creation aiming to optimize the enteral nutrition therapy for critically ill adult patients.
  
  
  METHODS
  Pubmed, SciELO, Scholar Google, Web of Science, Scopus, with research of these key words: protocols, enteral nutrition, nutritional support, critical care, undernutrition, fasting.
  
  
  METHODS
  Intensive Care Unit, Hospital de Clínicas, Federal University of Uberlándia, MG, Brazil.
  
  
  RESULTS
  Were established in the algorithm a following sequential steps: After a clinical-surgical diagnosis, including the assessment of hemodynamic stability, were requested passage of a feeding tube in post-pyloric position and a drainage tube in gastric position. After hemodynamic stability it should be done the nutritional status diagnosis, calculated nutritional requirements, as well as chosen formulation of enteral feeding. Unless contraindicated, aiming to increase tolerance was started infusion with small volumes (15 ml/h) of a semi-elemental diet, normocaloric, hypolipidic (also hyperproteic, with addition of glutamine). To ensure infusion of the diet, as well as the progressive increase of infusion rates, the patient was monitored for moderate or severe intestinal intolerance. The schedule and infusion rates were respected and diet was not routinely suspended for procedures and diagnostic tests, unless indicated by the medical team.
  
  
  CONCLUSIONS
  For nutrition therapy success it is essential routine monitoring and extensive interaction between the professionals involved. Nutritional conducts should be reevaluated and improved, seeking complete and specialized care to the critically ill patients. Adherence to new practices is challenging, though instruments such as protocols and algorithms help making information more accessible and comprehensible.
authors.affiliation: Postgraduate Program in Health Sciences and Nutrition Course, Faculty of Medicine of Federal University of Uberlândia, Uberlândia, MG, Brazil.
authors.forename: L
authors.initials: L
authors.lastname: Araújo-Junqueira
authors.forename: Daurea A
authors.initials: DA
authors.lastname: De-Souza
mesh_terms: D000465:Algorithms; D016638:Critical Illness / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods*; D005526:Food, Formulated; D006801:Humans; D044342:Malnutrition / Q000150:complications; D009752:Nutritional Status