Review for 10.1186/s12876-025-04122-4 (2025)

Title: Analysis of influencing factors and nursing strategies for enteral nutrition patients
complicated with refeeding syndrome in ICU
Version: 1 Date: 14 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the introduction describes the symptoms of RS, it lacks a detailed explanation of
the mechanisms underlying the syndrome. This is important for readers unfamiliar with the
pathophysiology of RS, as understanding these mechanisms can provide deeper insight into the
study’s focus and the nursing interventions discussed.
-Although the study is conducted in an ICU setting, the introduction does not explore the specific
challenges or unique aspects of ICU care that might contribute to the risk of RS (e.g., the impact
of critical illness on nutritional absorption, the use of medications, or the high metabolic stress of
ICU patients). A more thorough exploration of these challenges would strengthen the argument
for why this patient population requires special attention.
-The introduction references general data on RS, but it could benefit from citing more recent
studies or data specific to ICU patients receiving enteral nutrition. While there is a general
acknowledgment of increased mortality and morbidity, it could be useful to provide more
quantitative data to underscore the significance of the issue and demonstrate the need for further
research.
-While the outcome measures are briefly outlined, there is a limited explanation of how the
nursing intervention outcomes (i.e., serum phosphorus, potassium, magnesium, albumin, and
prealbumin levels) were monitored over time. It would be beneficial to provide more detail on
the timing of these measurements and any follow-up assessments after the intervention to gauge
the sustained impact.
-The nursing strategies in the observation group are well-defined but could benefit from
additional detail. For instance, how frequently electrolyte abnormalities were corrected, the
specific targets for blood sugar control, and the clinical signs used to assess fluid retention
would add clarity. Furthermore, specifying how individualized these interventions were based
on patient-specific characteristics (e.g., comorbidities, severity of illness) would improve the
understanding of the targeted approach.
-While the discussion mentions electrolyte imbalances as a key feature of RS, there is still a lack
of in-depth explanation regarding the pathophysiology of RS. The discussion could benefit from
more details about how RS leads to these disturbances and why the interventions are effective
in addressing these issues. A more detailed exploration of the metabolic processes (e.g., insulin
secretion, and shifts in electrolytes) could enhance understanding.
-While the study identifies several risk factors for RS, the discussion does not explore potential
confounding variables in detail. For example, ICU patients are often subject to a variety of
interventions (e.g., medications, comorbidities) that could contribute to electrolyte imbalances.
A more thorough discussion of these factors and how they might have influenced the results
would be helpful.