mNEED: a Multicentre, Cluster-randomized, Controlled Trial

Intolerance to enteral feeding for any clinical reason (vomiting, high gastric residue, diarrhea, gastrointestinal bleeding, etc.). FI should be considered present if at least 20 kcal/kg BW/day via enteral route cannot be reached within 72 h of feeding attempt or if enteral feeding has to be stopped for whatever clinical reason.

Vomiting: Any visible regurgitation of gastric contents, regardless of volume.

High Gastric Residual Volume (GRV): GRV > 200 mL per single measurement, assessed every 4 hours via syringe aspiration from the gastric/jejunal tube.

Diarrhea: Three or more loose or liquid stools per day, with a stool weight greater than 200-250 g/day (or greater than 250 mL/day).

Gastrointestinal Bleeding: Any bleeding within the gastrointestinal lumen, confirmed by visible blood in vomitus, gastric aspirate, or stool.

Proportion of Participants Achieving Nutritional Goals (Caloric Intake: 25 kcal/kg/day; Protein Intake: 1.3 g/kg/day) at Day 7 in the ICU Definition: The proportion of critically ill patients achieving at least 80% of their nutritional goals (caloric intake: 25 kcal/kg/day; protein intake: 1.3 g/kg/day) by Day 7 in the ICU. Nutritional intake will be calculated based on daily enteral and parenteral nutrition records, including calorie and protein intake data extracted from electronic medical records or nutrition monitoring tools.

Death on the 28th day after ICU admission

Death on the 90th day after ICU admission

SF-36 (Short Form-36 Health Survey) Score at Day 28 and Day 90 After ICU Admission Definition: The SF-36 is a widely used, patient-reported survey of health-related quality of life. It consists of 36 items covering eight health domains: physical functioning, role limitations due to physical health, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems, and mental health. Each domain is scored on a scale of 0 to 100, with higher scores indicating better health status. The SF-36 score will be assessed at Day 28 and Day 90 after ICU admission.

EuroQol 5-Dimension 5-Level (EQ-5D-5L) Score at Day 28 and Day 90 After ICU Admission Definition: The EQ-5D-5L is a standardized instrument for measuring health-related quality of life. It consists of five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension has five levels of severity (no problems, slight problems, moderate problems, severe problems, and extreme problems).

Measure the thickest part of the diaphragm during inspiration (when inhaling). Use a 5-15 MHz linear array probe positioned between the mid-axillary and anterior axillary lines at the 8th to 11th intercostal spaces, with the marker pointing cephalad. The diaphragm is typically located at a depth of 2 to 4 cm and appears as a three-layered structure between the pleural and peritoneal lines. It is recommended to measure the diaphragm thickness perpendicular to the fibrous direction between the pleural and peritoneal lines, excluding the membrane.

With the lower limb lying flat, the midpoint of the line connecting the upper edge of the patella and the anterior superior iliac spine is used as the measurement point. A 5-15 MHz linear array probe is placed perpendicular to the femur, applying minimal probe pressure to avoid deformation of subcutaneous fat and muscle.

With the lower limb lying flat, the measurement point is located at the lower third of the line connecting the anterior superior iliac spine and the upper edge of the patella. A 5-15 MHz linear array probe is placed perpendicular to the femur, applying minimal probe pressure to avoid deformation of subcutaneous fat and muscle. For patients with a larger muscle cross-sectional area, if the width of the linear probe cannot provide a complete view of the muscle, a convex array probe may be used instead.

With the upper limb lying flat, the measurement point is located at the lower two-thirds of the distance between the acromion and the antecubital fossa. The thickness measurement includes the biceps brachii and brachialis muscles, spanning from the superficial fascia of the biceps brachii to the uppermost part of the humerus. A 5-15 MHz linear array probe is placed perpendicular to the humerus, applying minimal probe pressure to avoid deformation of subcutaneous fat and muscle.

Incidence of New Infections in the ICU After 48 Hours of Admission Definition: The occurrence of new infections in the ICU, diagnosed after 48 hours of ICU admission, as confirmed by clinical, laboratory, or imaging criteria. Infections include but are not limited to ventilator-associated pneumonia (VAP), catheter-related bloodstream infections (CRBSI), and urinary tract infections (UTI). The observation period will be from 48 hours after ICU admission to ICU discharge, with a maximum assessment period of 90 days.

Length of ICU Stay Definition: The duration of stay in the ICU, measured in days, from the date of ICU admission to the date of ICU discharge. The maximum observation period will be 90 days.

The number of days in the ICU during which no ventilator was used