PURPOSE OF REVIEW: Protein delivery in the critically ill still is a highly debated issue. Here, we discuss only the most recent updates in the literature concerning protein nutrition of the critically ill.

RECENT FINDINGS: Up to now, there are no randomized controlled trials (RCTs) published on enteral provision of protein that were randomized for protein level of intake. In the past year, there have been two new observational studies published, one of which in critically ill children. Also, two randomized controlled trials with high parenteral amino acid provision have been published. The overall view on nutrition support has not been changed convincingly by these studies. Recent findings have confirmed that protein and amino acid provision are highly important for outcome in critically ill patients. For the first time, a randomized study confirmed this, however, only on the short term. The other RCT confirmed that an extreme dosing of amino acids is not related to improvement in outcome. One observational study showed that the effect of protein on outcome should be adjusted for energy intake and vice versa, showing that adequate protein is related to improved outcome and adequate energy provision is not. The other observational study confirmed importance of protein in paediatric ICU but also gained some insight into improvement of protein delivery by postpyloric feeding and usefulness of a dedicated dietitian in the ICU.

SUMMARY: We will continue to improve protein delivery to critically ill patients; however, the quest for evidence and feeding guidelines still remains.