PROTEIN PROVISION AND ENTERAL NUTRITION SAFETY IN CRITICALLY ILL ADULTS WITH BURNS AND SHOCK: A CRITICAL NARRATIVE REVIEW

Abstract

Protein provision and the initiation of enteral nutrition in critically ill adults require consideration of illness phase, circulatory stability, and the population studied. This study aimed to critically examine evidence on protein provision and enteral nutrition safety in burns and shock. A critical narrative review was conducted, with bibliographic verification and targeted supplementary research in October 2026. Fourteen addresses from a preliminary bibliography corresponded to 11 distinct publications, of which ten were incorporated. Supplementary selection added six clinical trials and four recommendation documents, yielding 20 sources. The synthesis distinguished protein dose, energy delivery, feeding route, and timing, without meta-analysis or an exhaustive-search claim. In burn patients, studies identified difficulties achieving targets and described higher-protein protocols, but did not establish the dose causally associated with better outcomes. In sepsis, favorable associations between protein adequacy and survival remained susceptible to confounding. Multicenter trials involving broader critically ill populations did not demonstrate consistent clinical benefit from early intensified protein provision. Feeding-timing studies could not establish protein requirements, and the selected evidence lacked findings directly applicable to isolated hypovolemic shock. Protein prescription should therefore be progressive and individualized, contingent on adequate resuscitation, tolerance, and clinical monitoring. Targets for major burns should not be automatically extrapolated to septic or hemorrhagic shock, and higher provision should not be interpreted as a guarantee of benefit.