Impact of a Staged Enteral Nutrition Nursing Pathway Based on Dynamic Assessment of Tolerance and Aspiration Risk vs Usual Care on Feeding Intolerance in Older Adult Patients With Acute Ischemic Stroke and Dysphagia: A Single-Center Randomized Controlled Trial.

BACKGROUND Older adult patients with acute ischemic stroke have dysphagia and require early post-pyloric enteral nutrition, yet feeding intolerance and unstable energy delivery remain common, and practical pathways that integrate tolerance and aspiration risk are lacking. This trial evaluated whether a dual-axis staged nursing pathway, compared with usual care, was associated with lower feeding intolerance and better nutritional delivery. MATERIAL AND METHODS This single-center, parallel, 1: 1 randomized controlled trial enrolled older adult patients with acute ischemic stroke and dysphagia with post-pyloric nasoenteric tubes placed. The intervention group received a staged nursing pathway, and the control group received usual care. The primary outcome was 7-day feeding intolerance; secondary outcomes were time to ≥80% of target, target-achieving days, aspiration-related pneumonia, and safety. Analyses were intention-to-treat. RESULTS Compared with control, the intervention group had a lower 7-day risk of feeding intolerance (adjusted RR 0.61, 95% CI, 0.47-0.81; P=0.003); faster attainment of at least 80% of energy target (adjusted HR 1.65, log-rank P<0.001); target-achieving-day proportion was higher (difference 0.16, Holm-adjusted P=0.001); risk of aspiration-related pneumonia was lower (adjusted RR 0.54, Holm-adjusted P=0.041); and difference in feeding-related hypoxemia was not significant (P=0.189). No between-group differences were observed in tube displacement, upper gastrointestinal bleeding, or electrolyte disturbances (all P>0.05). Subgroup/sensitivity analyses were consistent. CONCLUSIONS A staged nursing pathway driven by dynamic dual-axis assessment was associated with lower feeding intolerance and earlier, more stable nutritional delivery in the context of post-pyloric feeding, without increasing short-term safety events.