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Bundle Statement
Assess patients on admission to the intensive care unit (ICU) for nutrition risk, and calculate both energy and protein requirements to determine goals of nutrition therapy.
Initiate enteral nutrition (EN) within 24-48 hours following the onset of critical illness and admission to the ICU, and increase to goals over the first week of ICU stay.
Take steps as needed to reduce risk of aspiration or improve tolerance to gastric feeding (use prokinetic agent, continuous infusion, chlorhexidine mouthwash, elevate the head of bed, and divert level of feeding in the gastrointestinal tract.)
Implement enteral feeding protocols with institution-specific strategies to promote delivery of EN.
Do not use gastric residual volumes as part of routine care to monitor ICU patients receiving EN.
Start parenteral nutrition early when EN is not feasible or sufficient in high-risk or poorly nourished patients.