Abstract
<title>Abstract</title> <p> <bold>Background</bold> Early enteral nutrition is recommended for mechanically ventilated critically ill patients when the gastrointestinal tract is functional. However, implementation in routine intensive care unit practice may vary according to patient tolerance, clinical judgment, and local resources. This study described clinical outcomes following implementation of an early enteral nutrition initiation and monitoring approach in mechanically ventilated critically ill patients. <bold>Methods</bold> A historical-control observational study was conducted in a 15-bed intensive care unit at a governmental hospital in Palestine. Eighty adult mechanically ventilated patients were included: 40 patients managed during the protocol period and 40 historical controls managed during routine care. The protocol-period approach emphasized enteral nutrition initiation within 24 to 48 hours when clinically eligible, bedside monitoring of tolerance, intake and output recording, and documentation of gastrointestinal and tube-related complications. The approach did not include a fixed feeding-rate algorithm, standardized advancement schedule, or uniform calorie/protein target calculation. Clinical outcomes were summarized and compared descriptively and statistically between groups. <bold>Results</bold> The groups were similar with respect to available demographic characteristics, but detailed baseline severity indicators were not available in a sufficiently complete and standardized format. The protocol-period group had a shorter ICU length of stay than the historical control group (5.0 vs. 6.0 days, p=0.005) and showed more favorable recorded physiological, ventilatory, and neurological indicators during the observation period. No major infectious complications were recorded in the protocol-period group; however, comparable structured complication data were not available for the historical control group. Comparable calorie and protein delivery data were also unavailable. <bold>Conclusion</bold> Implementation of an early enteral nutrition initiation and monitoring approach was associated with more favorable recorded clinical outcomes in this single-center historical comparison. However, because of the non-randomized historical-control design and limited baseline severity data, the findings should be interpreted as exploratory and hypothesis-generating. Prospective studies with concurrent controls, standardized nutritional delivery measures, and baseline severity adjustment are needed. <bold>Trial registration</bold> : ClinicalTrials.gov Identifier: NCT07131098. Registered retrospectively on 12 August 2025. </p>