GNRI-stratified enteral nutrition reduces complications and ventilation duration in elderly ICU patientsNew nutrition plan helps elderly patients in intensive care

To develop a clinically feasible enteral nutrition protocol for elderly mechanically ventilated patients in the intensive care unit (ICU) based on the Geriatric Nutritional Risk Index (GNRI) stratification, and to preliminarily evaluate its effects on nutritional indicators, gastrointestinal complications, mechanical ventilation duration, and hospital length of stay. Based on systematic literature review and multidisciplinary discussion, a preliminary GNRI-stratified enteral nutrition protocol was formulated. Two rounds of Delphi consultation were conducted among 20 experts to revise and optimize the protocol. A single-center, non-concurrent controlled study was performed in 128 elderly mechanically ventilated patients (63 in the experimental group and 65 in the control group). The experimental group received the standardized GNRI-stratified enteral nutrition protocol, while the control group received conventional nutritional management. The primary outcomes included serum albumin and hemoglobin at 1 week [adjusted by analysis of covariance (ANCOVA) and multivariable linear regression]. Secondary outcomes included enteral nutrition-related complications (analyzed by multivariable logistic regression), mechanical ventilation duration, and hospital length of stay (analyzed by Mann-Whitney U test). The expert authority coefficients were 0.83 and 0.87 in the two rounds, and Kendall's W coefficients were 0.299 and 0.335 (both P < 0.001), indicating high expert consensus. The final protocol included 5 primary indicators, 14 secondary indicators, and 31 tertiary indicators. After adjustment for baseline levels, the experimental group had significantly higher albumin and hemoglobin at 1 week than the control group (both P < 0.001). The overall incidence of enteral nutrition-related complications was significantly lower (7.9% vs. 20.0%, P = 0.040), and the adjusted risk of complications was reduced (OR = 0.178, 95%CI: 0.072–0.442, P < 0.001). The experimental group also presented significantly shorter mechanical ventilation duration (median 128.0 vs. 172.0 h, P = 0.0243) and shorter hospital length of stay (P < 0.001). The GNRI-stratified enteral nutrition protocol developed using the Delphi method is scientific and clinically applicable. In this single-center non-concurrent study, implementation of the protocol was associated with improved nutritional indicators, fewer gastrointestinal complications, shorter mechanical ventilation duration, and shorter hospital stay in elderly mechanically ventilated ICU patients.