{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T07:01:02Z","timestamp":1790060462493,"version":"4.0.1"},"reference-count":45,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Achieving early enteral nutrition (EN) targets remains challenging in mechanically ventilated intensive care unit (ICU) patients. Evidence for nursing\u2010led multicomponent protocols incorporating traditional Chinese medicine (TCM) approaches is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To develop an integrated early EN management protocol using the Medical Research Council (MRC) framework and conduct a preliminary evaluation in mechanically ventilated ICU patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>A single\u2010centre quasi\u2010experimental before\u2010and\u2010after study was conducted in a tertiary ICU in China. Adults at nutritional risk receiving mechanical ventilation (MV) and EN were enrolled during sequential control and intervention phases. The intervention group received the MRC\u2010guided protocol and the control group received routine EN care. The primary outcome was EN target attainment on Days 3 and 7.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighty\u2010two patients were analysed (intervention,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200940; control,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200942). EN target attainment was higher in the intervention group on Day 3 (70.0%\u2009\u00b1\u200917.5% vs. 53.5%\u2009\u00b1\u200918.7%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; Cohen's\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20090.91) and Day 7 (83.7%\u2009\u00b1\u20099.4% vs. 64.1%\u2009\u00b1\u200915.4%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; Cohen's\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20091.53). Both differences remained significant after adjustment for calendar time. Earlier EN initiation and post\u2010pyloric feeding were associated with higher attainment in exploratory group\u2010adjusted analyses. Albumin showed a significant group\u2010by\u2010time interaction (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). MV duration, ICU length of stay and feeding intolerance did not differ significantly between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this single\u2010centre quasi\u2010experimental study, protocol implementation was associated with higher early EN target attainment and was feasible in the study setting, without a detected increase in feeding intolerance. Causal inference is limited by the before\u2010and\u2010after design, and component\u2010specific effects require evaluation in multicentre randomised controlled trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Clinical Practice<\/jats:title>\n                    <jats:p>The protocol provides critical care nurses with a structured approach to early EN delivery, tolerance monitoring and supportive care. Implementation elsewhere requires context\u2010specific adaptation and further evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nicc.70683","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T12:45:13Z","timestamp":1789562713000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of an Integrated Early Enteral Nutrition Management Protocol on Nutritional Target Attainment in Mechanically Ventilated\n                    <scp>ICU<\/scp>\n                    Patients: A Quasi\u2010Experimental Study Guided by the\n                    <scp>MRC<\/scp>\n                    Framework"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0515-4485","authenticated-orcid":false,"given":"Jie","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Nursing Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5381-7005","authenticated-orcid":false,"given":"Nan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Nursing Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongqing","family":"Hang","sequence":"additional","affiliation":[{"name":"Department of EICU Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinya","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of EICU Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of EICU Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2946-5517","authenticated-orcid":false,"given":"Peibei","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Nursing Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30176-3"},{"issue":"3","key":"e_1_2_12_3_1","first-page":"171","article-title":"Nutritional Assessment in Critically Ill Patients","volume":"41","author":"Hejazi N.","year":"2016","journal-title":"Iranian Journal of Medical Sciences"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2023.07.011"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-025-05309-7"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0148607115621863"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2025.1555311"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/0148607114526450"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnesp.2022.04.014"},{"issue":"15","key":"e_1_2_12_10_1","first-page":"2269","article-title":"Current Status of the Application of Appropriate Traditional Chinese Medicine Techniques for Enteral Nutrition Intolerance in Critically Ill Patients","volume":"19","author":"Xu K. 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