Purpose of Review <p>Many critical care clinicians are unfamiliar with management principals or recent studies that guide nutritional optimization of patients in the cardiac intensive care unit (CICU). The goal of this review is to describe the prevalence of malnutrition in the CICU, the frameworks for malnutrition diagnosis and assessment of skeletal muscle wasting, and the potential clinical consequences of improper feeding practices.</p> Recent findings <p>Malnutrition is common and has been linked to poor outcomes across various CICU patient populations. Several nutritional randomized controlled trials have refined best practices around the timing of enteral nutrition and the selection of protein intake targets in the intensive care setting. A hypocaloric, rather than normocaloric, feeding regimen usually preferred during the early phase of critical illness, and it is important to await adequate gut perfusion before uptitrating enteral feeds.</p> Summary <p>There is an evolving evidence base that defines current practice in CICU nutritional management, albeit with multiple knowledge gaps warranting further study.</p>