Effect of an Integrated Early Enteral Nutrition Management Protocol on Nutritional Target Attainment in Mechanically Ventilated ICU Patients: A Quasi-Experimental Study Guided by the MRC Framework
Item Type: Journal Article
Authors: Zhang, Jie;Wang, Nan;Hang, Yongqing;Huang, Jinya;Yang, Ping and Duan, Peibei
Publication Date: 2026
Journal: Nursing in Critical Care 31(5), pp. e70683
Abstract:
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.
Access or request full text: https://libkey.io/10.1111/nicc.70683
Access or request full text: https://libkey.io/10.1111/nicc.70683
