ABSTRACT
Critical care providers may be overcome with an abundance of information on a daily basis. In a 1998 editorial titled “Bringing Evidence to the Clinic,” the authors point out that physicians must read 19 articles a day, 365 days per year to remain current in their clinical practice (Davidoff et al. 1995). A broad search for critical care nutrition results in nearly 4000 records. Roughly 250 clinical trials related to early enteral nutrition (EN) and parenteral nutrition (PN) in critically ill patients combined have been published over the past year. Remaining current with the proliferation of clinical literature can create a daunting task for health-care providers. Decision support tools such as guidelines and protocols in most cases are developed by expert review of systematic research and can provide guidance to the clinician to translate evidence at the bedside. The Canadian Clinical Practice Guidelines (Heyland et al. 2003), the Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient (Martindale et al. 2009), and the European Society for Parenteral and Enteral Nutrition Guidelines (Kreymann et al. 2006, Bozetti and Forbes 2009) offer comprehensive recommendations for optimal nutrition therapy in the intensive care unit (ICU). The guidelines are disseminated and revised periodically, serving as an excellent foundation upon which to build evidence-based practice. Numerous nutrition therapy protocols have been established to improve the nutritional adequacy of critically ill patients; yet, observational studies comparing guideline implementation to bedside practice indicate a signicant gap in translating knowledge into performance. The practice guidelines may act to lter the plethora of information for critical care providers and teams; however, the heterogeneity and complexity of critical
Introduction .................................................................................................................................... 653 Review of the Evidence for Enteral and Parenteral Feeding Protocols ......................................... 655 Elements of Feeding Protocols ...................................................................................................... 656 Barriers to Adequate Enteral Nutrition and Protocol Compliance ................................................. 657
Provider and System-Related Barriers ...................................................................................... 657 Monitoring Gastric Residual Volumes ...................................................................................... 658 Achieving Protocol Compliance ...............................................................................................660
