Effect of an Integrated Early Enteral Nutrition Management Protocol on Nutritional Target Attainment in Mechanically Ventilated ICU Patients: A Quasi-Experimental Study Guided by the MRC Framework.

Before-and-after design without randomisation: control and intervention phases did not overlap, so staff learning, seasonal changes or other concurrent practice changes could explain part of the difference. Single centre in China with 82 patients analysed; the planned effect was optimistic, and the study was not powered for secondary outcomes. The intervention had five modules and many components, so the contribution of Chinese medicine techniques, early initiation, post-pyloric feeding or other parts cannot be separated. Albumin and prealbumin are nonspecific and influenced by inflammation, fluid shifts and disease recovery, so they do not prove nutritional efficacy. No significant differences were found in feeding intolerance, ventilation duration or ICU stay, but the study was not designed to show equivalence or detect small differences in these outcomes. Chinese medicine techniques may not transfer outside China without adaptation to local scope of practice, training, materials and patient preferences.

The authors declared no conflicts of interest. Funding came from Jiangsu Province Hospital of Chinese Medicine.

Do not conclude that Chinese medicine techniques caused better feeding delivery. The protocol bundled assessment, feeding strategy, tolerance monitoring, support measures and quality control, and the before-and-after design cannot separate the components.