Design and application of an enteral nutrition nursing checklist based on whole-course nutrition management in critically ill neurological patients

Abstract

Objective To evaluate the effect of implementing an enteral nutrition (EN) nursing checklist based on whole-course nutrition management in critically ill neurological patients. Methods In this prospective before-and-after cohort study, critically ill patients receiving enteral nutrition (EN) in the neurological intensive care unit (NICU) from May 2020 to December 2022 were enrolled. Patients admitted between May 2020 and August 2021 were assigned to the control group (n = 21) and received standard EN care, while those admitted between September 2021 and December 2022 were assigned to the observation group (n = 20) and received care guided by an EN nursing checklist based on whole-course nutrition management. Outcomes included EN tolerance indicators (abdominal distension, vomiting, diarrhea, gastric retention, and aspiration), EN intolerance score (sum of five complications), EN interruption rate, and clinical outcomes at NICU discharge. Results Baseline characteristics were comparable between groups (P > 0.05). The observation group demonstrated significantly lower incidences of diarrhea (15.0% vs. 52.4%, P = 0.015), gastric retention (15.0% vs. 42.9%, P = 0.043), and a numerically lower but not statistically significant incidence of aspiration (0.0% vs. 19.0%, P = 0.107). The EN intolerance score was significantly lower in the observation group (0.65 ± 0.81 vs. 1.86 ± 1.46, P = 0.002, 95% CI: −1.96 to −0.46; Cohen's d = 1.02). The EN interruption rate was lower in the observation group (15.0% vs. 42.9%, P = 0.049) and clinical improvement at NICU discharge was higher (90.0% vs. 61.9%, P = 0.036), but neither of these secondary outcomes remained significant after Benjamini-Hochberg false discovery rate (FDR) correction (adjusted P = 0.086 and P = 0.084, respectively). Among the seven secondary outcome comparisons, o secondary outcome retained statistical significance at the 0.05 level the primary outcome (EN intolerance score) remained significant as prespecified. Conclusion Implementation of an EN nursing checklist based on whole-course nutrition management appeared to be associated with improved EN tolerance, particularly in the primary outcome of EN intolerance score, and suggested reduced feeding interruptions and more favorable short-term clinical outcomes. These findings warrant validation in larger randomized controlled trials.