title: Enteral nutrition protocols for critically ill patients: are they necessary?
abstract: OBJECTIVE
  Nutrition therapy protocols seek to correlate current scientific knowledge with clinical practice by converting evidence-based efficacy data into clinical effectiveness. Implementing nutrition therapy protocols should be justified by their impact on clinical outcomes. Thus, our objective was to analyze studies that verified the effect of implementing protocols for enteral nutrition (EN) in critically ill patients who are mechanically ventilated. We investigated initiation of nutrition therapy, time until nutrition requirements are met, optimization of protein and energy intake, duration of mechanical ventilation, length of hospital and intensive care unit stay, mortality, and adherence to protocols.
  
  
  METHODS
  We reviewed studies of human adults published over a 14-year period in English, Portuguese, French, or Spanish and available in MEDLINE, LILACS, EMBASE, and CINAHL databases. Reference lists of the most relevant articles were also searched. The Medical Subject Heading (MeSH) terms searched were (enteral nutrition) subheading (therapy) AND (critical care) OR (critical illness) OR (intensive care). Terms were searched for in both the title and abstract.
  
  
  RESULTS
  Nineteen studies were included. Nutrition therapy was optimized after the implementation of nutrition protocols in all studies. However, the impact on clinical outcomes was modest.
  
  
  CONCLUSIONS
  Our analysis of previously published studies indicates that implementing a nutrition therapy protocol can lead to optimization of various aspects of nutrition practice. Further studies that take into consideration local facilitating (as well as hindering) factors may reveal the impact of strategic EN protocols on clinical outcomes.
authors.affiliation: Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital of the University of São Paulo School of Medicine, São Paulo, Brazil amgcordeiro@uol.com.br.
authors.forename: Andréa Maria Cordeiro
authors.initials: AM
authors.lastname: Ventura
authors.affiliation: Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Dan L
authors.initials: DL
authors.lastname: Waitzberg
mesh_terms: D002985:Clinical Protocols; D016638:Critical Illness / Q000628:therapy*; D016208:Databases, Factual; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D009751:Nutritional Requirements; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial
keywords: artificial respiration; critical care; critical illness; enteral nutrition; intensive care; mechanical ventilation; therapy