Objective To evaluate the effect of different enteral nutrition pathways on ventilator-associated pneumonia (VAP) in patients undergoing mechanical ventilation in intensive care unit (ICU) through network Meta-analysis. Methods Randomized controlled trials on the effect of enteral nutrition on VAP in mechanically ventilated ICU patients were retrieved from the Cochrane Library, PubMed, EMbase, Web of Science, CNKI, WanFang Data, VIP and CBM databases. After literature screening, data extraction and quality evaluation of the included literatures, Bayesian network Meta-analysis was performed using the R4.1.3 Gemtc program package. Results A total of 46 literatures were included in the analysis, involving 3 510 patients and 5 enteral nutrition pathways (nasointestinal tube, nasogastric tube, gastrointestinal double-lumen tube, gastrostomy tube, gastrojejunostomy tube). Network Meta-analysis results showed that in terms of reducing the incidence of VAP, nasointestinal tube, gastrointestinal double-lumen tube, gastrojejunostomy tube and gastrostomy tube were all superior to nasogastric tube (all P < 0.05). Gastrostomy tube was the best, followed by gastrojejunostomy tube and gastrointestinal double-lumen tube. In terms of shortening mechanical ventilation time, nasointestinal tube, gastrointestinal double-lumen tube and gastrostomy tube were all superior to nasogastric tube (all P < 0.05). In terms of shortening the length of stay in ICU, nasointestinal tube and gastrostomy tube were both superior to nasogastric tube (both P < 0.05), In terms of shor-tening duration of mechanical ventilation and length of hospital stay, gastrostomy tube was the best, followed by nasointestinal tube and gastrojejunostomy tube. Conclusion Gastrostomy, gastrojejunostomy and gastrointestinal double-lumen tube have advantages in reducing the incidence of VAP in ICU patients with mechanical ventilation. Gastrostomy tube, nasointestinal tube and gastrojejunostomy tube have advantages in reducing the duration of mechanical ventilation and the length of ICU stay of patients undergoing mechanical ventilation. However, the results should be carefully explained due to the limited number and quality of the included studies.