Objective To develop enteral nutrition (EN) protocol based on intra-abdominal pressure (IAP) grading and to evaluate the clinical effect.Methods Eighty critically ill patients with intra-abdominal hypertension admitted to the intensive care unit from April to November 2023 were assigned to two groups chronologically, with 40 in each group.The control group was given routine EN, while the intervention group received EN based on the IAP grading.The effect was evaluated after 7 consecutive days of intervention.Results Thirty-seven patients in the intervention group and 38 patients in the control group completed the study.The intervention group had significantly lower incidence of feeding intolerance, higher concentrations of total protein, albumin, prealbumin, and hemoglobin, as well as shorter time required to achieve target-feeding rate compared with the control group （all P＜0.05）.Conclusion EN guided by IAP grading for ICU patients with intra-abdominal hypertension can reduce the incidence of feeding into-lerance, enhance the feeding efficiency, and improve nutritional status of patients.