Association of an evidence-informed nasogastric enteral nutrition nursing pathway with gastrointestinal recovery and nutritional status in neurosurgical critical care: a retrospective quasi-experimental cohort study.

BACKGROUND

Critically ill neurosurgical patients frequently require nasogastric enteral nutrition (EN), yet impaired consciousness, dysphagia, ventilation, and gastrointestinal dysmotility predispose to underfeeding and intolerance. We evaluated whether implementation of an evidence-informed nasogastric EN nursing pathway was associated with improved gastrointestinal recovery and nutritional status in routine neurosurgical critical care.

METHODS

This single-center retrospective quasi-experimental cohort study reviewed consecutive adults requiring nasogastric EN in a neurosurgical intensive care unit between January 2022 and January 2024. Patients managed before pathway implementation formed the usual-care cohort (n = 56) and those managed afterward the evidence-informed pathway cohort (n = 56); a defined implementation transition interval was excluded a priori. Primary outcomes were time to initial EN tolerance, first documented flatus, and first defecation. Secondary outcomes were 7-day feeding compliance, 14-day feeding intolerance, and serial nutritional biomarkers. Effect estimates are reported with 95% confidence intervals (CIs).

RESULTS

Baseline characteristics were balanced. Compared with usual care, the pathway cohort had shorter time to initial EN tolerance (mean difference, -1.30 days; 95% CI, -1.88 to -0.72), first documented flatus (-1.60 days; 95% CI, -1.88 to -1.32), and first defecation (-1.60 days; 95% CI, -2.04 to -1.16; all P < 0.001). Seven-day feeding compliance was higher (92.86% versus 69.64%; risk difference, 23.2 percentage points; 95% CI, 9.4-37.0; P = 0.002), and 14-day feeding intolerance was lower (10.71% versus 28.57%; risk difference, -17.9 percentage points; 95% CI, -32.2 to -3.5; P = 0.032). Hemoglobin, albumin, and prealbumin increased in both cohorts, with greater gains in the pathway cohort and significant group-by-time interactions (P < 0.001). Documented adherence to the core pathway elements was high, with a composite adherence of 87.5%.

CONCLUSION

The evidence-informed nasogastric EN nursing pathway was associated with faster documented gastrointestinal recovery, higher feeding compliance, fewer intolerance events, and more favorable nutritional biomarker trajectories. Because the design was nonrandomized, findings are associative and warrant prospective multicenter confirmation.