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Nursing Implications of Enteral Nutrition Timing in Sepsis Patients Stratified by Modified NUTRIC Score: A Retrospective Observational Study

Year: 2026

Type: article

Abstract: BACKGROUND: Nutritional support is vital for patients with sepsis in the intensive care unit (ICU). Despite consensus on the importance of early enteral feeding, evidence is limited regarding the optimal enteral feeding initiation timing. AIM: This study aimed to evaluate the association between the timing of enteral nutrition initiation and clinical outcomes in sepsis patients stratified by the modified Nutrition Risk in Critically Ill (NUTRIC) score in the ICU, with a focus on nursing practice and patient care optimisation. STUDY DESIGN: A retrospective observational study was conducted using medical records of adult ICU patients with sepsis at a single tertiary hospital between January 2014 and August 2022. Nutritional risk was assessed using the modified NUTRIC score. RESULTS: Among the 613 patients, 271 were classified as having low nutritional risk, and 342 were classified as having high nutritional risk. The timing of EN initiation was not significantly associated with clinical outcomes in low-risk patients. In high-risk patients, EN initiation within 24-48 h was associated with lower ICU mortality than initiation within the first 24 h (20.37% vs. 36.82%, OR = 1.200, 95% CI: 1.04-1.38)and after 48 h (20.37% vs. 34.34%, OR = 1.149, 95% CI: 0.98-1.34, p = 0.042). The incidence of feeding intolerance decreased from 45.5% in the group of EN initiated during 24 h to 44.44% within 24-48 h (OR = 1.010, 95% CI: 0.87-1.16), and to 25.25% in the group initiated after 48 h (OR = 0.828, 95% CI: 0.70-0.96, p = 0.002). Nevertheless, no significant differences were observed in the duration of mechanical ventilation or lengths of intensive care unit (ICU) or hospital stay across EN timing groups in either risk subgroup. CONCLUSIONS: Early initiation of EN (< 24 h) in sepsis patients with high nutritional risk is associated with increased mortality; initiation within 24-48 h may be a better choice for these patients. This highlights the need for nursing professionals to tailor EN initiation based on the patient's nutritional risk to optimise outcomes. RELEVANCE TO CLINICAL PRACTICE: EN initiation timing is associated with ICU mortality for sepsis patients; nurses should pay attention to the optimal timing for EN in sepsis patients, especially for those with high nutritional risk.

Source: Nursing in Critical Care

DOI: 10.1111/nicc.70394