Application of an ACE Star Model–Based Evidence-Based Enteral Nutrition Management Protocol in Neurocritical Care Patients

Why It Matters

Reducing feeding intolerance accelerates nutritional recovery, shortens ICU stays, and can improve survival in high‑risk neurocritical patients. The study shows systematic, evidence‑based nutrition management yields measurable clinical and operational benefits.

Key Takeaways

• Evidence‑based protocol cut feeding intolerance by over 50%.
• Target feeding achievement rose to 69% from 38%.
• Serum albumin and prealbumin levels significantly improved.
• Staff adherence to EN guidelines increased to near 100%.
• Protocol reduces FI risk, odds ratio 0.16.

Pulse Analysis

Enteral nutrition (EN) is the cornerstone of supportive care for patients with acute brain injuries, yet feeding intolerance (FI) remains a pervasive obstacle, affecting up to half of neurocritical admissions. FI not only compromises caloric delivery but also prolongs mechanical ventilation, raises infection risk, and inflates hospital costs. Traditional EN practices often rely on individual clinician judgment, resulting in inconsistent feeding strategies and delayed recognition of gastrointestinal complications. In this high‑stakes environment, a structured, evidence‑driven approach can align multidisciplinary teams around clear, reproducible actions.

The ACE Star model offers a five‑step framework—problem identification, evidence synthesis, translation, integration, and outcome evaluation—that translates the latest research into bedside protocols. By mapping FI prevention onto this model, the study introduced standardized assessments, ultrasound‑guided motility checks, temperature‑controlled formulas, and proactive rate adjustments. The resulting protocol slashed FI incidence from 70% to 31% and more than doubled the rate of patients achieving prescribed caloric targets. Biochemical markers of nutrition, such as albumin and prealbumin, improved markedly, underscoring the physiological impact of consistent EN delivery. Moreover, staff adherence to the ten evidence‑based criteria rose to near‑perfect levels, highlighting the protocol’s feasibility and the power of targeted education.

For health systems, the implications extend beyond immediate patient outcomes. Lower FI rates translate into shorter ICU stays, reduced reliance on costly interventions like parenteral nutrition, and potentially lower mortality. The study’s methodology—combining rigorous literature appraisal with real‑time clinical feedback—provides a replicable template for other specialties confronting protocol variability. Future research should quantify long‑term cost savings, explore scalability across diverse hospital settings, and integrate digital decision‑support tools to sustain adherence. Embracing ACE Star‑guided EN protocols could become a benchmark for quality improvement in neurocritical care.