BACKGROUND: Worldwide, malnutrition is an important issue in the care of the critically ill which is associated with increased costs of care and poor patient outcomes.

OBJECTIVES: To evaluate the current state of enteral nutrition in the critically ill in the U.S. in comparison to international practices.

RESEARCH METHODOLOGY/DESIGN: A retrospective chart audit was performed utilising a 10% random sample of patients admitted to the Pulmonary Medicine Service at an academic medical center in the U.S. from 1/1/11 to 12/31/11. A total of 69 charts were audited.

OUTCOME MEASURES: Outcome measures included time to initiation of feeds, prescribed versus received protein and energy on day three, prokinetic use and markers of nutritional status.

RESULTS: Delayed time to feeding, greater than 48hours after ICU admission, was present in 66.7% of the sample. On day three only 9% of the sample was receiving 80% or more of the prescribed protein or energy. These findings are similar to those found internationally.

CONCLUSION: Critically ill patients continue to experience delays in enteral feeding initiation and are frequently not meeting nutrition targets. Interventions aimed at improving nutrition delivery in the intensive care unit should be a focus of quality care both in the U.S. and internationally.