Nutritional support is a vital component of managing critically ill patients. We occasionally encounter difficulty in the management of enteral nutrition (EN) due to vomiting or diarrhea in patients in the intensive care unit (ICU). To standardize and evaluate EN in ICU, we used the patient condition to adapt the clinical pathway (CP) for EN to patients hospitalized in our ICU in 2008 who could not intake nutrients orally. All 117 who satisfied the entry criteria among 414 ICU patients were entered into this CP. Eighty-nine (76.1%) patients achieved the outcome of CP in 7.1+4.9 days. Gastrointestinal complications, including reflux and diarrhea, were observed in 35 patients (29.9%) during EN. Twentysix of these 35 patients (74.3%) required regulation of EN due to reflux, diarrhea (five patients, 14.3%), or both (four patients, 11.4%). Twenty-two patients (62.9%) required more than four days for regulation of EN, and ten of these 22 patients died. We concluded that nutritional management is difficult for many patients, such as those with severe cerebral vessel disease, severe sepsis, and patients with decreased cardiac function, who required early EN.