An enhanced nutrition support system is associated with greater adequacy of enteral nutrition in long-term ICU patients: a retrospective cohort study

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BACKGROUND: Nutritional management strategies for long-term ICU patients remain insufficiently established. This study evaluated the association between implementing an enhanced nutrition support system and enteral nutrition (EN) adequacy and related care indicators in patients with prolonged ICU stay. METHODS: In this single-center retrospective study, 85 adults with ICU stay ≥ 14 days were assigned to the conventional (January 2019 to October 2021; n = 48) or enhanced (November 2021 to March 2024; n = 37) groups based on hospital adoption of the enhanced nutrition support system, without patient-level prospective assignment or randomization. During the enhanced period, this system-comprising full-time dietitian assignment, standardized EN protocols for oral and tube feeding, systematic nutritional assessment, and intolerance management-was provided as routine care from ICU day 1. All variables were retrospectively abstracted from electronic medical records. Primary outcomes were presence of EN on day 14 (oral and/or tube), presence of oral intake on day 14, and daily EN adequacy (energy and protein sufficiency) over ICU days 1-14. Secondary outcomes included ratio of central venous catheter (CVC) placement days, antibiotic administration days ratio, positive blood culture rates, and incidence of gastrointestinal intolerance symptoms (diarrhea, constipation, vomiting). RESULTS: On day 14, the enhanced group showed significantly higher rates of EN presence (78.4% vs. 52.1%, p = 0.013) and oral intake presence (35.1% vs. 12.5%, p = 0.013) than did the conventional group. Significant group-by-day interactions for energy and protein adequacy rates (both, p < 0.001) indicated steeper increases over time in the enhanced group. The median ratio of CVC placement days was lower in the enhanced group than in the conventional group (35.1% vs. 63.1%, p = 0.035). No significant differences were found between the groups in gastrointestinal intolerance symptoms, antibiotic administration days ratio, or positive blood culture rates. CONCLUSIONS: Implementation of an enhanced nutrition support system was associated with higher EN adequacy, higher day-14 EN and oral intake rates, and lower CVC use in long-term ICU patients, without increasing gastrointestinal intolerance. These findings support the adoption of multidisciplinary, protocol-based nutrition support as a standard approach for ICU patients at high nutritional risk.

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