Malnutrition is a frequent and consequential problem among critically ill patients, associated with increased mortality, morbidity and healthcare costs. This study aimed to evaluate how current enteral nutrition (EN) practices in Turkish intensive care units align with established clinical nutrition guidelines. The focus was on initiation timing, tube selection, administration method, achievement of calorie and protein goals, handling of EN interruptions, and use of prokinetic agents.
This was a multicentre, prospective, point-prevalence study conducted in six intensive care units in Türkiye. The study used two prespecified point-prevalence dates: 30 July and 30 August 2025. Eligibility required adult patients (≥18 years) who had remained in the ICU for at least 48 hours and who had received EN for a minimum of 24 hours on either study date. All patients meeting these criteria were included; no intervention was performed as part of the study.
Existing EN practices were compared with a protocol derived from guideline recommendations issued by the European Society for Clinical Nutrition and Metabolism (ESPEN), the American Society for Parenteral and Enteral Nutrition (ASPEN) and the Turkish Society of Clinical Enteral and Parenteral Nutrition (KEPAN). The primary outcome measures included: timing of EN initiation, type of enteral tube, method of EN administration, percentage of energy and protein requirements achieved, management of conditions that required EN interruption, and use of prokinetic agents.
Ninety-eight patients met inclusion criteria. Sixty patients (61.2%) were male. The median age was 72 years with an interquartile range of 59 to 79 years. The study reported baseline clinical scores and comorbidity burden relevant to nutrition risk and illness severity; details on specific counts of comorbid conditions were used in subsequent analyses of nutritional target achievement.
Enteral nutrition was initiated within 48 hours of ICU admission in 72 patients, representing 73.5% of the cohort. Thirteen patients (13.3%) experienced delays in initiation that lacked a clinical justification per the study report. These findings were assessed relative to guideline recommendations advocating early commencement of EN when feasible in critically ill patients.
The median percentage of administered energy relative to prescribed targets was 87% (IQR 69.6%–100%). For protein, the median percentage achieved was 82% (IQR 64.9%–100%). Despite these median values, only 27 patients (27.6%) achieved 100% of both energy and protein requirements. The distribution around the medians indicates that a substantial proportion of patients received subtarget nutrition, even when overall adherence to guideline processes was considered high.
The study identified several factors statistically associated with failing to reach full nutritional targets. A higher number of comorbidities was associated with failure to meet targets (p=0.007). Higher body mass index was also linked to target shortfalls (p=0.017). Renal dysfunction was another significant association (p=0.041). These associations suggest patient-related complexity and organ dysfunction play a role in achieving prescribed calorie and protein goals.
In 14 patients (14.3%), enteral nutrition was continued despite the presence of contraindications. The subgroup of patients in whom EN continued despite contraindications had significantly higher illness severity and nutrition-risk scores: Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Nutrition Risk in Critically Ill (NUTRIC) scores, according to the source text. The report implies a need to review decision-making around EN continuation when contraindications are present.
The study evaluated type of enteral feeding tube and method of administration, and it assessed the use of prokinetic agents as part of guideline adherence. Specific frequencies for tube types and administration methods were collected and compared to guideline recommendations. The authors noted that optimisation of prokinetic agent use represented an area for improvement, though the source did not provide additional granular data on dosing, agent selection or precise usage rates.
According to the authors, overall adherence to guideline recommendations among patients receiving enteral nutrition was high. Nonetheless, the study identified important gaps: only about one quarter of patients met full energy and protein targets, some EN initiations were unjustifiably delayed, EN was continued in a subset despite contraindications, and optimisation of prokinetic therapy was needed. No interventions were implemented in this observational protocol; the study serves as a cross-sectional evaluation of real-world practice against ESPEN, ASPEN and KEPAN standards. The source did not report further details on subsequent local quality-improvement actions or long-term outcomes related to the identified gaps.