Implementation of an Enteral Nutrition Protocol in the Cardiac Care Unit　- A Retrospective Study of Critically Ill...

Enteral nutrition (EN) is often delayed in critically ill cardiovascular patients due to concerns about bowel ischemia, especially when under vasopressor or mechanical support. We evaluated the impact of a structured EN protocol designed to promote timely and safe nutrition delivery in the Cardiac Care Unit (CCU).

This single-center retrospective study compared mechanically ventilated CCU patients before (April 2019-March 2020) and after (April 2022-March 2023) protocol implementation. The protocol specified hemodynamic safety thresholds and used a peptide-based formula. Outcomes included EN-related complications, time to EN initiation, and nutritional adequacy within the first week. A total of 116 patients (58 per group) were analyzed. No significant differences were observed in vomiting (P=0.717), diarrhea (P=0.219), or bowel ischemia (P=0.364). The post-protocol group showed a significantly shorter time to EN initiation (median 39.5 vs. 76.0 h; P<0.001). By Day 5, enteral energy adequacy improved (40.8% vs. 12.3%; P<0.001), and protein adequacy increased (62.2% vs. 31.0%; P<0.001). Exploratory analyses showed no significant differences in CCU stay, ventilator-free days, or in-hospital deaths.

The EN protocol enabled earlier initiation and improved EN delivery in high-risk CCU patients without increasing complications, offering a safe and practical approach to narrowing the gap between guidelines and practice.