Evaluation of guideline adherence in enteral nutrition practices among ICU patients: a point prevalence study.

Authors

Betül Özgan, Yunus Emre Ayhan, Özge Özmen, Damla Sosyal, Güneş Eskidemir, Halime Yılmaz, Ahmet Çakır, Sıdıka Yetimoğlu, Ayşe Gül Koçoğlu Kınal, Muhammed Yunus Bektay, Hayrettin Daşkaya, Kazım Karaaslan, Funda Datlı Yakaryılmaz

Published in

BMJ open. Volume 16. Issue 9. Pages e120718. Sep 02, 2026. Epub Sep 02, 2026.

Abstract

Malnutrition is a significant problem in critically ill patients and is associated with higher mortality, morbidity and healthcare costs. Enteral nutrition (EN), being more physiological than parenteral nutrition, helps reduce complications. This study evaluated how well EN practices in Turkish intensive care units (ICUs) align with current clinical nutrition guidelines.
This multicentre, prospective, point-prevalence study was carried out in six ICUs in Türkiye.
Adult patients (≥18 years) who had stayed in the ICU for at least 48 hours and had received EN for a minimum of 24 hours on either of the two prespecified point-prevalence dates (30 July and 30 August 2025) were eligible. All patients meeting these criteria were included.
No intervention was performed. Existing EN practices were evaluated against guideline-based recommendations.
EN practices were assessed according to initiation time, type of EN tube, method of EN administration, rate of achieving calorie and protein target, management of conditions requiring EN interruption and use of prokinetic agents. Guideline adherence was evaluated using a protocol based on European Society for Clinical Nutrition and Metabolism (ESPEN), American Society for Parenteral and Enteral Nutrition (ASPEN) and Turkish Society of Clinical Enteral and Parenteral Nutrition (KEPAN) recommendations.
98 patients were included; 60 patients (61.2%) were male, and the median age was 72 (IQR 59-79) years. EN was initiated within 48 hours in 72 patients (73.5%), while 13 (13.3%) delays lacked clinical justification. The median percentage of administered energy and protein compared with the targets was 87% (IQR 69.6%-100%) and 82% (IQR 64.9%-100%), respectively. However, only 27 patients (27.6%) achieved 100% of both energy and protein requirements. Failure to achieve nutritional targets was significantly associated with a higher number of comorbidities (p=0.007), higher body mass index (p=0.017) and renal dysfunction (p=0.041). EN continued despite contraindications in 14 patients (14.3%), who had significantly higher Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Nutrition Risk in Critically Ill (NUTRIC scores (all p<0.05).
Among patients receiving EN, overall adherence to guideline recommendations was high. However, improvements are needed in achieving nutritional targets and optimising prokinetic use.

PMID:
42692507
Bibliographic data and abstract were imported from PubMed on 04 Sep 2026.

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