Jie Zhang, Nan Wang, Yongqing Hang, Jinya Huang, Ping Yang, Peibei Duan
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.
BACKGROUND: 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.
AIMS: 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.
STUDY DESIGN: 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.
RESULTS: 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.
CONCLUSIONS: 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.
RELEVANCE TO CLINICAL PRACTICE: 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.