Background: The current status of nutritional support for patients in Respiratory ICU across mainland China remains inadequately characterized. This multi-center study, conducted in RICUs, was designed to investigate nutritional practices in this specific patient population, focusing on initiation timing, energy/protein adequacy, and associations with clinical outcomes. Methods: A prospective, observational study enrolled 1,026 patients (ICU stay >48 h) across 68 Chinese RICUs. We analyzed EN initiation rates (24 h/48 h), caloric/protein intake adequacy during the first 7 days, and outcomes via multivariable Cox regression. Results: EN initiation occurred in 36.8% (24 h) and 43.4% (48 h) of patients. Excluding patients who could take oral food, the proportion of patients who started EN within 24 and 48 h increased to 86.9 and 95.3%. Among 499 EN-fed patients, 26.1% developed EN complications. Caloric analysis (n = 317) identified three trajectories: underfeeding (<70% targets, 32.5%), adequate feeding (70-110, 43.2%), and overfeeding (>110, 24.3%). Overfeeding independently predicted higher non-social infections and significantly increased mortality risk in patients >50 years (HR = 1.83, 95% CI 1.02-3.28; p = 0.04). Mean protein intake was 0.9 g/kg/day, with no 28-day mortality benefit at higher thresholds (>= 1.2 g/kg: p = 0.31; >= 1.3 g/kg: p = 0.42). Conclusion: This multicenter study demonstrates optimal early EN initiation rates in Chinese RICUs. Energy overfeeding was associated with increased mortality risk only in patients >50 years and non-social infections risk, whereas protein adequacy showed no outcome associations. Protocolized EN delivery balancing adequacy and overfeeding risks is urgently needed in RICUs.
[1]Chinese Acad Med Sci, Natl Ctr Resp Med, Natl Clin Res Ctr Resp Dis,China Japan Friendship, State Key Lab Resp Hlth & Multimorbid,Ctr Resp Med, Beijing, Peoples R China.
[2]Huazhong Univ Sci & Technol, Cent Hosp Wuhan, Tongji Med Coll, Dept Resp & Crit Care Med, Wuhan, Peoples R China.
[3]Peking Univ Third Hosp, Dept Resp & Crit Care Med, Beijing, Peoples R China.
[4]Chinese Acad Med Sci, Cardiovasc Inst, Natl Ctr Cardiovasc Dis, Med Res & Biometr Ctr, Beijing, Peoples R China.
[5]Meizhou Peoples Hosp, Dept Resp & Crit Care Med, Meizhou, Peoples R China.
[6]Dezhou Peoples Hosp, Dept Resp & Crit Care Med, Dezhou, Peoples R China.
[7]Kunming Med Univ, Dept Resp & Crit Care Med, Affiliated Hosp 1, Kunming, Yunnan, Peoples R China.
[8]China Med Univ, Affiliated Hosp 4, Dept Resp & Crit Care Med, Shenyang, Peoples R China.
[9]Inner Mongolia Baogang Hosp, Resp & Crit Care Med Dept, Baotou, Peoples R China.
[10]Wuhan Univ, Dept Resp & Crit Care Med, Zhongnan Hosp, Wuhan, Peoples R China.
[11]Cent South Univ, Dept Resp & Crit Care Med, Xiangya Hosp 3, Changsha, Peoples R China.
[12]Soochow Univ, Dept Resp & Crit Care Med, Affiliated Hosp 1, Suzhou, Peoples R China.
[13]Henan Prov Peoples Hosp, Dept Resp & Crit Care Med, Zhengzhou, Peoples R China.
[14]Cent South Univ, Dept Resp & Crit Care Med, Xiangya Hosp 2, Changsha, Peoples R China.
[15]Tai City Cent Hosp, Resp ICU, Tai An, Peoples R China.
[16]First Peoples Hosp Yunnan Prov, Dept Resp & Crit Care Med, Kunming, Peoples R China.
[17]Med Ctr Chinese Peoples Armed Police Force, Intens Care Unit, Tianjin, Peoples R China.
[18]Cangzhou Cent Hosp, Dept Resp & Crit Care Med, Cangzhou, Peoples R China.
[19]Zhengzhou Univ, Dept Resp & Crit Care Med, Affiliated Hosp 1, Zhengzhou, Peoples R China.
[20]Cent South Univ, Xiangya Hosp, Dept Resp & Crit Care Med, Changsha, Peoples R China.
[21]Chongqing Med Univ, Dept Resp & Crit Care Med, Affiliated Hosp 2, Chongqing, Peoples R China.
[22]Sichuan Prov Peoples Hosp, Dept Resp & Crit Care Med, Chengdu, Peoples R China.
[23]2 Peoples Hosp Fuyang City, Dept Resp & Crit Care Med, Fuyang, Peoples R China.
[24]Nanjing Med Univ, Affiliated Huaian Peoples Hosp 1, Dept Resp & Crit Care Med, Nanjing, Peoples R China.
[25]Xi An Jiao Tong Univ, Dept Resp & Crit Care Med, Affiliated Hosp 1, Xian, Peoples R China.
[26]Hebei North Univ, Affiliated Hosp 1, Resp & Crit Care Med Dept, Shijiazhuang, Peoples R China.
[27]Second Mil Med Univ, Affiliated Hosp 1, Dept Resp & Crit Care Med, Shanghai, Peoples R China.
[28]Nanjing Univ, Med Sch, Dept Resp & Crit Care Med, Affiliated Drum Tower Hosp, Nanjing, Peoples R China.
[29]Gen Hosp Northern Theater Command, Dept Resp & Crit Care Med, Shenyang, Peoples R China.
[30]Dalian Med Univ, Affiliated Hosp 1, Dept Resp & Crit Care Med, Dalian, Peoples R China.
[31]Dali Bai Autonomous Prefecture Peoples Hosp, Dept Resp & Crit Care Med, Dali, Peoples R China.
[32]Fujian Med Univ, Longyan Affiliated Hosp 1, Dept Resp & Crit Care Med, Longyan, Peoples R China.
[33]Nanjing Med Univ, Nanjing Hosp 1, Dept Resp & Crit Care Med, Nanjing, Peoples R China.
[34]Second Hosp Jilin Univ, Dept Resp & Crit Care Med, Changchun, Peoples R China.
[35]Northern Jiangsu Peoples Hosp, Dept Resp & Crit Care Med, Yangzhou 225000, Peoples R China.
[36]First Hosp Jilin Univ, Dept Resp & Crit Care Med, Changchun, Peoples R China.
[37]Third Peoples Hosp Datong, Dept Resp & Crit Care Med, Datong, Peoples R China.
[38]Nanjing Med Univ, Dept Resp & Crit Care Med, Affiliated Jiangning Hosp, Nanjing, Peoples R China.
[39]USTC Univ Sci & Technol China, Affiliated Hosp 1, Dept Resp & Crit Care Med, Hefei, Peoples R China.
[40]Anhui Med Univ, Dept Resp & Crit Care Med, Affiliated Hosp 2, Hefei, Peoples R China.
[41]Huzhou Cent Hosp, Dept Resp & Crit Care Med, Huzhou, Peoples R China.
[42]Qingdao Univ, Dept Resp & Crit Care Med, Affiliated Yantai Yuhuangding Hosp, Yantai, Peoples R China.
[43]Shanxi Bethune Hosp, Dept Resp & Crit Care Med, Taiyuan, Peoples R China.
[44]Beijing Fangshan Liangxiang Hosp, Dept Resp & Crit Care Med, Beijing, Peoples R China.
[45]China Med Univ, Dept Resp & Crit Care Med, Hosp 1, Shenyang, Peoples R China.
[46]Tianjin Med Univ, Intens Care Unit, Hosp 2, Tianjin 300211, Peoples R China.
[47]Tongji Univ, East Hosp, Dept Resp & Crit Care Med, Shanghai, Peoples R China.
[48]Guizhou Prov Peoples Hosp, Dept Resp & Crit Care Med, Guiyang, Peoples R China.
[49]Air Force Mil Med Univ, Affiliated Hosp 1, Dept Resp & Crit Care Med, Xian, Peoples R China.
[50]Second Peoples Hosp Wuhu, Dept Resp & Crit Care Med, Wuhu, Peoples R China.
[51]Zhejiang Univ, Sch Med, Affiliated Hosp 4, Dept Resp & Crit Care Med, Yiwu, Peoples R China.
[52]Air Force Med Univ, Affiliated Hosp 2, Dept Resp & Crit Care Med, Xian, Peoples R China.
[53]Yangtze Univ, Dept Resp & Crit Care Med, Jingzhou Hosp, Jingzhou, Peoples R China.
[54]Beijing Jingmei Grp Gen Hosp, Dept Resp & Crit Care Med, Beijing, Peoples R China.
[55]Anhui Med Univ, Dept Resp & Crit Care Med, Affiliated Hosp 1, Hefei 230022, Peoples R China.
[56]Shenyang Med Coll, Dept Resp & Crit Care Med, Cent Hosp Affiliated, Shenyang, Peoples R China.
[57]First Peoples Hosp Changzhou, Dept Resp & Crit Care Med, Changzhou, Peoples R China.
[58]Shijiazhuang Peoples Hosp, Dept Resp & Crit Care Med, Shijiazhuang, Peoples R China.
[59]Suzhou Municipal Hosp, Dept Resp & Crit Care Med, Suzhou, Peoples R China.
[60]Tianjin Chest Hosp, Dept Resp & Crit Care Med, Tianjin, Peoples R China.
[61]Shanghai Jiao Tong Univ, Sch Med, Ruijin Hosp, Dept Resp & Crit Care Med, Shanghai, Peoples R China.
[62]Capital Med Univ, Beijing Rehabil Hosp, Dept Resp & Crit Care Med, Beijing, Peoples R China.
[63]Beijing Hosp, Dept Resp & Crit Care Med, Beijing, Peoples R China.
[64]First Hosp Lianyungang, Dept Resp & Crit Care Med, Lianyungang, Peoples R China.
[65]Hebei Med Univ, Dept Resp & Crit Care Med, Hosp 2, Shijiazhuang, Peoples R China.
[66]Gen Hosp Southern Theater Command PLA, Dept Resp & Crit Care Med, Guangzhou, Peoples R China.
[67]Zhuozhou City Hosp, Dept Resp & Crit Care Med, Zhuozhou, Peoples R China.
[68]Tangshan Ctr Hosp, Dept Resp & Crit Care Med, Tangshan, Peoples R China.
[69]Gelderse Vallei Hosp, Dept Intens Care Med & Res, Ede, Netherlands.
[70]Wageningen Univ & Res, Chair Grp Nutr Biol, Div Human Nutr & Hlth, Wageningen, Netherlands.
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