Effect of an Integrated Early Enteral Nutrition Management Protocol on Nutritional Target Attainment in Mechanically...

Achieving early enteral nutrition (EN) targets remains challenging in mechanically ventilated intensive care unit (ICU) patients. Evidence for nursing-led multicomponent protocols incorporating traditional Chinese medicine (TCM) approaches is limited.

To develop an integrated early EN management protocol using the Medical Research Council (MRC) framework and conduct a preliminary evaluation in mechanically ventilated ICU patients.

A single-centre quasi-experimental before-and-after study was conducted in a tertiary ICU in China. Adults at nutritional risk receiving mechanical ventilation (MV) and EN were enrolled during sequential control and intervention phases. The intervention group received the MRC-guided protocol and the control group received routine EN care. The primary outcome was EN target attainment on Days 3 and 7.

Eighty-two patients were analysed (intervention, n = 40; control, n = 42). EN target attainment was higher in the intervention group on Day 3 (70.0% ± 17.5% vs. 53.5% ± 18.7%; p < 0.001; Cohen's d = 0.91) and Day 7 (83.7% ± 9.4% vs. 64.1% ± 15.4%; p < 0.001; Cohen's d = 1.53). Both differences remained significant after adjustment for calendar time. Earlier EN initiation and post-pyloric feeding were associated with higher attainment in exploratory group-adjusted analyses. Albumin showed a significant group-by-time interaction (p = 0.002). MV duration, ICU length of stay and feeding intolerance did not differ significantly between groups.

In this single-centre quasi-experimental study, protocol implementation was associated with higher early EN target attainment and was feasible in the study setting, without a detected increase in feeding intolerance. Causal inference is limited by the before-and-after design, and component-specific effects require evaluation in multicentre randomised controlled trials.

The protocol provides critical care nurses with a structured approach to early EN delivery, tolerance monitoring and supportive care. Implementation elsewhere requires context-specific adaptation and further evaluation.