Evidence-Based Program Linked to Lower Refeeding Syndrome Rates in ICU Patients

A structured, evidence-based risk management program for refeeding syndrome was associated with a substantially lower incidence of this potentially life-threatening metabolic complication among critically ill patients receiving nutritional support, according to a sequential multiphase study conducted in the intensive care unit of Jingzhou Hospital Affiliated to Yangtze University in China. In the quasi-experimental evaluation, refeeding syndrome developed in 18.8 percent of patients cared for under the new program, compared with 59.4 percent of patients who received routine care, a difference the researchers report as statistically significant.

Refeeding syndrome is recognized as a serious and potentially life-threatening metabolic complication that can arise in critically ill patients receiving enteral or parenteral nutrition. Early identification and timely risk management are widely regarded as important components of prevention, yet the study team notes that standardized, structured risk management strategies for the condition in intensive care settings have remained limited, potentially hindering early recognition and timely prevention at the bedside.

The research unfolded in sequential phases. First, the investigators developed a risk management program through evidence synthesis, then refined it through two rounds of Delphi expert consultation. Only after this development and refinement phase did the team move to the preliminary evaluation, which used a quasi-experimental design with historical controls rather than random assignment.

The resulting program bundled five core components: early risk screening, individualized nutrition support, dynamic electrolyte monitoring, thiamine supplementation, and multidisciplinary collaboration. Together, these elements form what the authors describe as a structured framework to support risk identification, tailored nutritional support, continuous monitoring, and cooperative decision-making in everyday intensive care practice.

Eligible participants were adults aged 18 years or older who were receiving enteral or parenteral nutritional support and were expected to remain in the intensive care unit for at least five days. At baseline, each patient’s nutritional risk was assessed with the NRS-2002 screening tool, while disease severity was measured with the APACHE II score. Patients admitted between March and May 2025 formed the control group and received routine care, whereas patients admitted from June to October 2025 received the evidence-based risk management program as the intervention group.

A total of 64 patients were included in the evaluation, evenly split with 32 patients in each arm. The primary outcome was the incidence of refeeding syndrome, and the contrast between the groups was stark. Patients managed under the program experienced the complication at less than one-third the rate seen under routine care, with a relative risk of 0.32 and a 95 percent confidence interval of 0.15 to 0.69, yielding a p-value of 0.001. In absolute terms, roughly six of every ten routine-care patients developed refeeding syndrome, compared with fewer than two in ten under the program.

Secondary outcomes pointed in the same direction. On day five of nutritional support, the intervention and control groups differed significantly in serum potassium, magnesium, calcium, and phosphorus levels, all with p-values below 0.05, consistent with the program’s emphasis on dynamic electrolyte monitoring. Serum albumin and prealbumin, markers of nutritional status, were both higher in the intervention group, with p-values below 0.001. Length of stay in the intensive care unit was also shorter under the program, with a median of 9.0 days compared with 12.0 days in the control group, and the reported p-value was 0.001.

The authors conclude that implementing the evidence-based risk management program was associated with a reduced incidence of refeeding syndrome, improved short-term nutritional and biochemical outcomes, and a shorter intensive care stay among critically ill patients receiving nutritional support. The findings address a recognized gap, since prior work has concentrated on risk screening, nutritional support strategies, and management recommendations, while structured, evidence-based programs for intensive care settings have been scarce.

Several features of the study warrant caution when interpreting the results. The evaluation was a preliminary, single-center quasi-experiment that relied on historical controls, meaning patients treated before the program’s rollout served as the comparison group rather than concurrent patients randomly assigned to either approach. The sample of 64 patients is modest, and the intervention and control periods differed in calendar time, both of which can introduce bias. The authors themselves frame the work as a development and preliminary evaluation, positioning the program as a promising framework for risk identification, individualized nutrition support, dynamic monitoring, and multidisciplinary collaboration that now requires further validation before broader adoption in intensive care practice.

Subject of Research: Development, implementation, and preliminary evaluation of an evidence-based risk management program for refeeding syndrome in critically ill patients receiving nutritional support: a sequential multiphase study

Article Title: Development, implementation, and preliminary evaluation of an evidence-based risk management program for refeeding syndrome in critically ill patients receiving nutritional support: a sequential multiphase study

Article References: Wang, X.-E., Zhang, X., Zeng, X.-R., Fu, W.-F., Yang, X.-R., Hu, H.-H., & Ding, J. (2026). Development, implementation, and preliminary evaluation of an evidence-based risk management program for refeeding syndrome in critically ill patients receiving nutritional support: a sequential multiphase study. BMC Nursing. https://doi.org/10.1186/s12912-026-05356-7

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05356-7

Keywords: Development, implementation, preliminary, evaluation, evidence-based, risk, management, program, refeeding, syndrome, critically, patients