Clinical nutrition open science · 2026
Real-world implementation of a standardized ICU protocol for daytime-restricted enteral nutrition in critically ill adults: A retrospective quality improvement study.
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McClain Amanda C, Marian Marian, Dickin Katherine L, Dollahite Jamie S
Аннотация
BACKGROUND: Enteral nutrition (EN) delivery is often interrupted in the intensive care unit (ICU), and while continuous 24-hour feeding is standard practice, emerging evidence from circadian biology and pilot trials suggests that daytime-restricted EN may enhance nutritional adequacy and patient outcomes by aligning feeding with biological rhythms.
METHODS: This quality improvement study describes a novel, standardized daytime-restricted EN protocol in a community hospital ICU and retrospectively evaluate its real-world implementation. The protocol involved a stepwise transition in EN delivery, beginning with continuous trophic feeding (acute/initial phase), followed by daytime-restricted 12-hour cyclic feeding (anabolic recovery phase), and advancing to intermittent daytime-restricted feeding (chronic recovery phase). A convenience sample of 22 adult ICU patients (12 received continuous 24-hour EN; 10 with the daytime-restricted EN protocol) was analyzed. Clinical data were extracted from electronic medical records, including EN infusion rates, duration, and interruptions.
RESULTS: Patients in the daytime-restricted group received EN at higher infusion rates (median 87.5 vs. 40.0 mL/hr), over fewer hours per day (11.0 vs. 14.5 hours), experienced fewer interruptions (1.0 vs. 9.5 hours/day), and received a greater percentage of their prescribed nutritional volume (90.0% vs. 57.5%) compared to the continuous group (all P value < 0.05). Vomiting was more frequently reported in the daytime-restricted group, while constipation was more common in the continuous group, though these differences were not statistically significant.
CONCLUSION: This preliminary evaluation supports the feasibility of implementing a daytime-restricted EN protocol in an adult ICU and suggests potential advantages in delivery consistency and nutritional adequacy. To support broader implementation, larger prospective studies across broader ICU populations are necessary.
METHODS: This quality improvement study describes a novel, standardized daytime-restricted EN protocol in a community hospital ICU and retrospectively evaluate its real-world implementation. The protocol involved a stepwise transition in EN delivery, beginning with continuous trophic feeding (acute/initial phase), followed by daytime-restricted 12-hour cyclic feeding (anabolic recovery phase), and advancing to intermittent daytime-restricted feeding (chronic recovery phase). A convenience sample of 22 adult ICU patients (12 received continuous 24-hour EN; 10 with the daytime-restricted EN protocol) was analyzed. Clinical data were extracted from electronic medical records, including EN infusion rates, duration, and interruptions.
RESULTS: Patients in the daytime-restricted group received EN at higher infusion rates (median 87.5 vs. 40.0 mL/hr), over fewer hours per day (11.0 vs. 14.5 hours), experienced fewer interruptions (1.0 vs. 9.5 hours/day), and received a greater percentage of their prescribed nutritional volume (90.0% vs. 57.5%) compared to the continuous group (all P value < 0.05). Vomiting was more frequently reported in the daytime-restricted group, while constipation was more common in the continuous group, though these differences were not statistically significant.
CONCLUSION: This preliminary evaluation supports the feasibility of implementing a daytime-restricted EN protocol in an adult ICU and suggests potential advantages in delivery consistency and nutritional adequacy. To support broader implementation, larger prospective studies across broader ICU populations are necessary.