Real-world implementation of a standardized ICU protocol for daytime-restricted enteral nutrition in critically ill adults: A retrospective quality improvement study
Bibliographic record
Abstract
Background: Enteral nutrition (EN) delivery is often interrupted in the intensive care unit (ICU), and while continuous 24-hour feeding is standard practice, emerging evidence from circadian biology and pilot trials suggests that daytime-restricted EN may enhance nutritional adequacy and patient outcomes by aligning feeding with biological rhythms. Methods: This quality improvement study describes a novel, standardized daytime-restricted EN protocol in a community hospital ICU and retrospectively evaluate its real-world implementation. The protocol involved a stepwise transition in EN delivery, beginning with continuous trophic feeding (acute/initial phase), followed by daytime-restricted 12-hour cyclic feeding (anabolic recovery phase), and advancing to intermittent daytime-restricted feeding (chronic recovery phase). A convenience sample of 22 adult ICU patients (12 received continuous 24-hour EN; 10 with the daytime-restricted EN protocol) was analyzed. Clinical data were extracted from electronic medical records, including EN infusion rates, duration, and interruptions. Results: value < 0.05). Vomiting was more frequently reported in the daytime-restricted group, while constipation was more common in the continuous group, though these differences were not statistically significant. Conclusion: This preliminary evaluation supports the feasibility of implementing a daytime-restricted EN protocol in an adult ICU and suggests potential advantages in delivery consistency and nutritional adequacy. To support broader implementation, larger prospective studies across broader ICU populations are necessary.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.045 | 0.067 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".