M alnutrition results when nutritional intake does not meet metabolic requirements. Critically ill patients are at an increased risk for malnutrition because of alterations in protein and energy metabolism displayed in response to trauma, major surgery, burns, and sepsis 1 and may be unable to tolerate oral nutrition. Critical care nurses are well positioned to screen patients at risk for malnutrition and to work in conjunction with the multidisciplinary team to develop and implement interventions to prevent and treat malnutrition. Interruptions in Enteral Nutrition Delivery in Critically Ill Patients and Recommendations for Clinical Practice MELISSA L. STEWART, RN, DNP, MSN, CCNS, CCRNThis article has been designated for CNE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. List consequences of malnutrition in critically ill patients 2. Discuss how current nursing routines may contribute to interruptions in enteral nutrition in critically ill patients 3. Describe nursing interventions to improve the delivery of nutrition to critically ill patients CNE Continuing Nursing EducationCover Malnutrition is common in critically ill patients and is associated with poor outcomes for patients and increased health care spending. Enteral nutrition is the method of choice for nutrition delivery. Enteral nutrition delivery practices vary widely, and underfeeding is widespread in critical care. Interruptions in enteral nutrition due to performance of procedures, positioning, technical issues with feeding accesses, and gastrointestinal intolerance contribute to underfeeding. Strategies such as head-of-bed positioning, use of prokinetic agents, tolerance of higher gastric residual volumes, consideration of postpyloric feeding access, and use of a nutrition support protocol may decrease time spent without nutrition. (Critical Care Nurse.

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The use of a nutrition support protocol appears to increase the efficacy of enteral nutrition delivery. Further research is needed to determine the effect of increased enteral nutrition adequacy on patient outcomes. The use of an evidenced-based protocol is recommended to improve protein and energy delivery in the critically ill.

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