A Structured Clinical Nutrition Pathway for Enteral Nutrition Management in Patients with Intracerebral Hemorrhage: A Non-Randomized Controlled Study

Why It Matters

Standardizing enteral nutrition in neurocritical care can lower complication rates, accelerate functional recovery, and cut costs, making it a critical quality‑improvement lever for stroke centers.

Key Takeaways

• SAPIM pathway cut nutrition complications from 56.7% to 30%
• Hospital stay reduced by about eight days with SAPIM protocol
• Albumin and prealbumin levels rose markedly under structured nutrition care
• ADL and NIHSS scores improved faster in SAPIM group
• Patient satisfaction reached near‑perfect levels after pathway implementation

Pulse Analysis

Intracerebral hemorrhage remains one of the deadliest stroke subtypes, with early metabolic instability and dysphagia driving high rates of malnutrition. International guidelines from ESPEN and ASPEN stress prompt risk screening and individualized feeding, yet many hospitals struggle to translate these recommendations into bedside practice. Inconsistent tube management, delayed assessments, and fragmented team communication often lead to feeding intolerance, aspiration, and prolonged intensive care stays, eroding both patient outcomes and hospital efficiency.

The SAPIM framework—Systematic assessment, Personalized intervention, and Multidisciplinary management—offers a pragmatic solution. By mandating nutrition risk scoring, targeted caloric and protein goals, and daily multidisciplinary huddles, the pathway creates a repeatable workflow that aligns nurses, dietitians, physicians, and therapists. The study’s data show a 26.7‑percentage‑point drop in enteral complications and an eight‑day reduction in length of stay, translating into substantial cost savings for high‑volume stroke units. Moreover, the marked rise in albumin and prealbumin levels signals better protein synthesis, while faster improvements in ADL and NIHSS suggest that nutritional stability may amplify neuro‑rehabilitation gains.

For health systems, adopting a structured nutrition pathway can become a competitive differentiator. It supports value‑based care metrics, improves patient satisfaction scores, and reduces readmission risk—key drivers in bundled payment models and quality reporting. Future multicenter trials should quantify long‑term functional outcomes and explore integration with electronic health record decision support, paving the way for scalable, data‑driven nutrition protocols across neurocritical care settings.