Effects on nutritional care practice after implementation of a flow chart-based nutrition support protocol in an intensive care unit.

Only 25 patients were studied before and 25 after; the authors noted this small number could increase the risk of bias. It was a single 10-bed ICU and a before-after record review, not a randomised comparison. The study did not measure patient outcomes such as mortality or infection, so improved enteral feeding was not shown to help patients clinically. Patients were not selected by gastrointestinal condition, and severity scores such as SAPS or APACHE were not recorded. Six patients before and three patients after were bypassed because height was not documented. The night and late-evening anaesthesiologists were not formally educated on the new protocol, which may have affected prescribing. Retrospective records could contain documentation errors that were not detected. After the new protocol, reaching energy goals took longer, and the gap between prescribed and administered energy was larger.

The authors declared no financial or proprietary interest in the subject matter or materials.

Do not conclude that the protocol improved overall nutrition or patient outcomes. Total energy given over 7 days was 71% of calculated requirements before and after, and the study did not measure mortality or infection.