Nutritional therapy in intensive care unit inpatients at risk for refeeding syndrome: A systematic review

•This is the first systematic review about refeeding syndrome (RS) in only critically ill patients.•In critically ill patients, hypophosphatemia sole may not be sufficient as a marker for RS.•Prevention of RS may conflict with prevention of malnutrition.•Future research needs to count calories in Kcal/Kg/D and proteins in g/Kg/D. [Display omitted] The profiles of intensive care cnit (ICU) critically ill inpatients differ from those of other hospitalized patients, since organ dysfunction is a factor that increases the risk for Refeeding Syndrome (RS) development. It is important to understand the influence of feeding methods and caloric intake on mortality and RS incidence among critically ill adult inpatients. A systematic search, following PRISMA guidelines and protocol for systematic reviews, was conducted for interventional and experimental studies analyzing RS occurrence in adults admitted to ICUs. Pubmed, Scielo, Lilacs, Google Scholar, Scopus and Web of Science were the databases searched, and the Scottish Intercollegiate Guidelines Network (SIGN) tool was used to assess methodological quality of selected articles. Out of 945 abstracts screened, 32 articles were read in full and 20 were included for data extraction. Considerable heterogeneity was found between all studies reviewed. Enteral feeding was the most used method, and, in general, progression of caloric intake did not follow the American Society of Parenteral and Enteral Nutrition (ASPEN) or National Institute of Health and Care (NICE) recommendations for RS. In majority, data collection period of studies was less than 7 days; RS was observed in up to 52.5% of patients, and related mortality varied between 15.6 and 83.3%. Due to weak level of evidence and high heterogeneity found within reviewed studies, it is not possible to determine a robust recommendation as to what would be the best and safest feeding method and caloric progression protocol for patients at risk for developing RS.