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. 2026 Sep 24;13:1886962. doi: 10.3389/fnut.2026.1886962

Table 1b.

Details of enteral nutrition interruption (ENI) and proposed interventions.

Study Incidence (%) Definition Feeding route Feeding mode Biochemical markers Causes of ENI Recommended interventions
Kasti et al. (32) 100 Unreported Unreported Unreported / 1. Diagnostic procedures (100%, median 3 h/d): Mainly high GRV monitoring (100%, median 3 h/d); 1. Develop interruption-minimizing protocols to reduce missed feeding hours
2. Interventional procedures (52%, median 3.1 h/d): mainly surgery (36%, median 2.8 h/d); 3. Patient-related (25%, median 1.2 h/d): mainly GI dysfunctions (9%) 2. Involve dietitians in the multidisciplinary team for daily nutritional assessment
3. Standardize GRV monitoring practices to avoid unnecessary ENI
4. Implement targeted micronutrient supplementation to address deficits
Arunkumar et al. (41) 89.07 Unreported Gastric route Continuous infusion Serum albumin, serum lactate Weaning & extubation (49.7%), tracheostomy (9.2%), bronchoalveolar lavage (9.3%), Imaging procedures (8.9%), GI intolerance (15.0%) 1. Define lower pre-procedure fasting targets
2. Restart EN promptly post-interruption
3. Use calorie-dense formulas for fluid-restricted patients
Binnekade et al. (24) 48 Unreported Gastric/intestinal route Progressive continuous infusion / Gastric retention, feeding tube type 1. Increase energy and protein density of formulas to improve nutritional yield
2. Standardize feeding tube use to avoid improper purposes (e.g., contrast delivery)
3. Optimize management of feeding intolerance (e.g., rational use of prokinetic drugs)
4. Conduct meticulous recording of intake and interfering factors to identify practice inadequacies
Davies et al. (25) 100 Unreported Unreported Unreported / 1. Fasting for extubation (pre/post) (41.7%); 2. Surgical intervention (26.9%); 3. Scans (16.4%); 4. Feeding tube displacement (common in weeks 3–4); 5. GI intolerance (36.0% of patients) 1. Minimize unnecessary fasting time (e.g., optimize pre-procedural fasting protocols)
2. Strengthen feeding tube management to reduce displacement
3. Improve management of feeding intolerance (rational use of prokinetics)
4. Develop trauma-specific nutrition guidelines to optimize energy and protein delivery
Ritter et al. (49) 30.77 Unreported Unreported Progressive continuous infusion / Vomiting/gastric residue (3.1%), surgery/tracheostomy (4.6%), extubation (4.6%), other/examinations (18.5%) 1. Develop and implement unit-specific standard protocols to monitor the duration of diet suspension
2. Optimize scheduling of therapeutic procedures to reduce unnecessary fasting
3. Strengthen multidisciplinary team collaboration to monitor and resume nutritional therapy promptly
Coutris et al. (37) 100 Unreported Gastric route Continuous infusion / Predictable (74.5%): perioperative period (main), extubation (secondary), tests/procedures (minor); unpredictable (25.5%): high GRV (main), emesis/nausea (secondary) 1. Compensate for predictable interruptions
2. Optimize feeding schedule around procedures
3. Use volume-based feeding goals
Czapran et al. (36) 55.56 Unreported Gastric/intestinal route Continuous infusion Serum glucose Fasting for surgery (47%), EN access loss (11%), extubation/intubation (8%), high GRV (7%), abdominal distension (7%) 1. Implement protein-energy provision via the enteral route protocol(PEP uP protocol)
2. Start enteral nutrition at goal rate early (within 24-48 h of admission).
3. Minimize feeding interruptions; compensate for unavoidable fasting
4. Prefer post-pyloric over gastric feeding.
5. Raise GRV threshold to avoid unnecessary feeding cessation.
6. Administer gastrokinetic agents early (day 1)
7. Consider glutamine supplementation (mean 29 g/day).
8. Use computer-aided tools for nutrition management
Davies et al. (43) 96.55 Unreported Gastric/intestinal route Continuous infusion Serum amylase, serum lipase, C-reactive protein, blood glucose Procedure outside ICU (16%), feeding tube dislodgement (15%), vomiting (8%), planned extubation (7%), procedure in ICU (5%), high GRV (4%), abdominal distension (3%), diarrhea (1%), aspiration (0.3%) 1. Disseminate clinical practice guidelines to promote early EN
2. Standardize nutritional therapy protocols for acute pancreatitis
3. Reduce clinician preference-driven PN use
Segaran et al. (44) 100 Unreported Gastric route Continuous infusion Blood glucose Imaging transfer (main cause), awaiting nasogastric tube insertion (secondary cause), fasting for airway procedures (tracheostomy/extubation) (key cause), surgery (important cause) 1. Develop ICU-specific fasting guidelines (no fasting for non-airway surgery/scans; 4 h fasting for airway procedures)
2. Provide focused education to medical/nursing staff on guidelines
3. Reinforce guideline adherence via daily ward rounds
4. Collaborate with anaesthetic department for protocol ratification
Elpern et al. (45) 100 Unreported Gastric route Progressive continuous infusion / Tests and procedures (35.7%), body position change (15%), unstable clinical conditions (13.5%), high GRV (11.5%), nausea & vomiting (9.2%), medication administration (7.7%), temporary EN access loss (3.4%), aspiration (2.1%), others (4.9%) 1. Establish and implement feeding protocols to standardize practices
2. Recalculate infusion rates considering projected “down time” (e.g., 18-h infusion instead of 24-h)
3. Limit infusion to periods with low risk of off-unit tests/procedures
4. Avoid unnecessary interruptions for transient body position changes
Erika et al. (6) 68.49 Unreported Unreported Unreported / 1. Patient-related (59%): mainly hemodynamic instability (20%), High GRV (17%), diarrhea (10%); 2. Interventional procedures (32%): mainly tracheostomy (16%), other surgeries (16%); 3. Diagnostic procedures (9%): mainly CT (6%), endoscopies (0.8% each) 1. Develop internationally recognized safe reduced-fasting guidelines for critically ill patients
2. Implement protocols advocating for shorter peri-procedural fasting times
3. Adopt volume-based feeding and “catching up” strategies after ENI
4. Involve ICU dietitians in nutrition management
Fang (15) 100 Unreported Gastric route Continuous infusion / 1. Difficult intubation (consciousness disturbance/bulbar palsy/improper fixation); 2. EN complications: Gastric retention (weak GI/mechanical ventilation), diarrhea (30%), hyperglycemia (30%), gastric tube blockage (6.7%); 3. Others: medical-nursing operations/fasting exams/economy/busy night shifts 1. Improve the success rate of one-time intubation: Adopt appropriate intubation methods (jaw lifting method, lateral position tongue pulling method, etc.) and strengthen fixation
2. Prevent and manage EN complications:
– Gastric retention: use enteral nutrition pump for continuous infusion, keep the head of the bed elevated after feeding
– Diarrhea: select appropriate nutrient solution, control temperature and infusion speed, prevent contamination
– Hyperglycemia: regularly monitor blood glucose and adjust nutrient solution or use insulin
– Gastric tube blockage: rinse the tube regularly, grind drugs before injection
3. Strengthen EN management: conduct professional training for nurses, reasonably arrange operations, communicate with family members to solve economic difficulties
Gong (14) 68.5 ≥15 min Gastric/intestinal route Continuous infusion / Medical-nursing operations, difficult intubation, GI intolerance 1. Use enteral nutrition tolerance assessment and management tools to grade feeding intolerance symptoms and conduct regular active assessment
2. Monitor the changing trend of gastric residual volume in critically ill patients by ultrasound and standardize gastric residual volume monitoring
3. Adopt nutritional risk assessment combined with individualized and targeted nutritional management processes to reduce EN-related complications
4. Formulate and implement early EN feeding processes for critically ill patients, strengthen multidisciplinary cooperation and relevant knowledge training
Habib et al. (39) 73.58 Unreported Gastric route Continuous infusion / BiPAP dependency (24.5%), tracheostomy (21.7%), preoperative fasting (16%), dialysis (17.9%) 1. Optimize BiPAP use to reduce interruptions
2. Minimize pre-surgical NPO duration
3. Standardize tracheostomy-related feeding management
Han et al. (11) 64.84 ≥10 min Unreported Unreported Albumin, total protein, hemoglobin Medical-nursing operations, diagnostic exams, pipeline factors, GI bleeding, hemodynamic instability, physical rehabilitation, dialysis, position change, equipment failure/delay 1. Avoid excessive use of analgesic and sedative drugs, dynamically assess the level of analgesia and sedation, and adopt a goal-directed analgesia and sedation strategy
2. Improve feeding tolerance management, use enteral nutrition tolerance assessment and management tools, and conduct hierarchical treatment of feeding intolerance
3. Establish an enteral nutrition checklist, train nurses on relevant knowledge and supervise the implementation, and improve the nutrition process
4. Establish a prevention and management strategy for ENI in ICU patients to reduce ENI caused by subjective factors
5. Provide practical ENI handling procedures to correctly respond to interruption events
Zheng et al. (21) 18.63 ≥30 min Gastric/intestinal route Continuous infusion / 1. Diagnostic & therapeutic procedures (50.9%); 2. Others: EN tube dysfunction/hemodynamic instability/anastomotic leakage/rehabilitation/patient refusal (26.8%); 3. GI intolerance (high GRV/abdominal distension/vomiting/diarrhea) (22.3%) 1. Establish comprehensive nutrition support protocols for critical care nurses
2. Strengthen training for department nurses to equip them with skills for preventing and managing ENI
3. Standardize EN management protocols to avoid unnecessary interruptions
4. Develop dynamic feeding algorithms integrating real-time gastrointestinal tolerance assessment and critical care treatment phases
Kim et al. (19) 55.32 Unreported Gastric route Intermittent feeding Prealbumin, transferrin; CRP Extubation/intubation (34.6%), GI bleeding (23.1%), High GRV (15.4%), condition deterioration (11.5%), external drainage tube insertion (7.7%), cerebral angiography (7.7%), others (3.8% each) 1. Develop evidence-based and safe clinical practice guidelines for enteral feeding management
2. Standardize the judgment criteria for stopping/delaying feeding (e.g., rationalize gastric residual volume cutoff values)
3. Avoid overprotective feeding management and reduce avoidable interruptions
4. Nurses should strictly follow standardized protocols to improve the adequacy of enteral feeding
Pinilla et al. (22) 56.25 Unreported Gastric route Continuous infusion Serum albumin, serum magnesium 1. GI intolerance: high GRV (Group I 53%/Group II 23%, p < 0.005), Vomiting (Group I 6%/Group II 7%), Diarrhea (Group I 11%/Group II 23%); 2. Others: Surgery (Group I 6/Group II 10), extubation (Group I 6/Group II 5), physiotherapy (3 each), EN tube issues/hypophosphatemia 1. Adopt higher gastric residual volume threshold (250 mL vs. 150 mL)
2. Mandatory prokinetic administration for all patients (metoclopramide, cisapride, domperidone)
3. Standardize enteral feeding progression protocol (start at 25 mL/h, increase by 25 mL/h every 4 h if tolerated)
Kim et al. (28) 70.59 Unreported Gastric route Intermittent feeding Serum albumin, C-reactive protein GI intolerance (29.5%, r = −0.874), routine care (1.4%), procedures (17.5%, r = −0.839), airway management (22.4%), GI bleeding (18.9%), EN tube issues (1.2%) 1. Develop standardized enteral feeding protocols
2. Provide continuing education for healthcare providers on nutritional support
3. Optimize GRV cutoff (current 50 mL may be too low)
4. Minimize fasting time before procedures
5. Flexible feeding schedule for intermittent bolus feeding
Lakshmi and Vaidyanathan (40) 60 Unreported Gastric route Unreported / Airway management (28%), surgical intervention (20%), GI intolerance (vomiting/diarrhea) (12%) 1. Implement tube feeding protocols to standardize practices and limit unnecessary interruptions
2. Strengthen coordination between multidisciplinary teams to reduce procedural interruptions
3. Optimize management of GI intolerance to minimize feeding cessation
O’Leary-Kelley et al. (42) 98.33 ≥15 min Gastric/intestinal route Continuous infusion / 1. ICU-related (65.1%): extubation/airway management (28.8%), preoperative fasting (23.4%), exam fasting (6.9%), etc.; 2. GI factors (19.8%): Vomiting (6.8%), high GRV (6.6%), etc.; 3. Tube factors (11.1%): dislodgement/clogging (4.6%/4.2% each) 1. Develop standardized enteral feeding protocols to limit unnecessary interruptions
2. Strengthen monitoring of daily nutritional intake by nursing staff
3. Advocate for early initiation of enteral feeding
4. Optimize timing of procedures to minimize feeding interruption duration
Li (17) 86.75 Unreported Gastric/intestinal route Continuous infusion Serum albumin, white blood cell count GI symptoms (47.59%), surgery (6.63%), exams (1.20%), rescue (0.60%), rehabilitation exercise (1.81%) 1. Establish nutrition support teams and develop standardized EN protocols
2. Conduct EN knowledge training for ICU doctors and nurses
3. Avoid unnecessary EN interruption; relieve gastrointestinal symptoms before suspending EN
4. Monitor serum albumin levels and supplement albumin if necessary
5. Adjust PEEP for mechanically ventilated patients and discontinue ventilation early
Ribeiro et al. (18) 100 Unreported Gastric route Progressive continuous infusion CRP 1. Internal (78.1%): extubation (29.9%), GI complications (21.4, 70% from high GRV), EN tube issues (17.9%), routine causes (8.9%); 2. External (21.9%): Tracheostomy (9.5%), endoscopy (5.5%), tomography (5.3%) 1. Optimize the management of internal causes of ICU, mobilize the entire medical team to control interruptions related to extubation, gastrointestinal complications and feeding tubes
2. Establish flowcharts to improve the logistics coordination with other hospital departments, reducing external cause interruptions
3. Strengthen the monitoring and intervention of patients with acute inflammatory response (elevated CRP) to improve nutritional tolerance
4. Pay attention to the nutritional support of elderly patients (>60 years old) and reduce the impact of dysphagia on oral route recovery
McClave et al. (29) 84.09 Unreported Gastric route Continuous infusion Serum albumin High GRV (45% patients, 15.14% duration), EN tube displacement (41% patients, 7.66% duration), procedures (39% patients, 34.99% duration), diagnostic exams (27% patients, 4.62% duration), others (32% patients, 36.15% duration) 1. Implement strict enteral feeding infusion protocols
2. Educate healthcare professionals on avoidable cessation reasons
3. Rationalize GRV management (200 mL as reasonable cutoff)
4. Shorten fasting time before procedures (up to 4 h before)
5. Use high-calorie dense formulas
6. Aggressive tube fixation to prevent displacement
O’Meara et al. (30) 100 ≥15 min Gastric route Continuous infusion / Small-bore EN tube issues (25.6%), High GRV (13.3%), weaning (11.7%), procedures (7.9%), surgery preparation (7.7%) 1. Optimize small-bore feeding tube management
2. Rethink residual volume monitoring thresholds
3. Minimize unnecessary interruptions for procedures/nursing care
Uozumi et al. (38) 100 Unreported Gastric/intestinal route Progressive continuous infusion / Undetermined causes (29%), airway manipulation (18%), GI events (abdominal pain/high GRV/vomiting/diarrhea/GI bleeding) (14%), dialysis (13%), ICU diagnostic-therapeutic procedures (11%), others (surgery/tracheostomy, etc.) 1. Develop a standardized protocol for EN interruption and resumption
2. Shorten unnecessary pre-procedural fasting time (e.g., follow 6-h fasting consensus for tracheostomy)
3. Improve staff awareness of calorie deficits caused by ENI
4. Document clear orders for EN interruption and resumption
Peev et al. (20) 68.09 ≥10 min Gastric/intestinal route Progressive continuous infusion Serum albumin, prealbumin, C-reactive protein Extubation/intubation (27.36%), Tracheostomy/PEG (21.70%), imaging exams (15.09, 87.5% avoidable), ortho procedures (11.32, 50% avoidable), High GRV (9.43%), others (5.66% each, 66.7% avoidable) 1. Maximize nutrient delivery before and after unavoidable EN interruptions
2. Adopt “PEP uP Protocol” (higher initial EN rate, prophylactic prokinetics, catch-up boluses)
3. Standardize periprocedural EN criteria
Van Nieuwkoop et al. (27) 68.85 Unreported Unreported Unreported / CT scan (23.5%), High GRV (16.5%), Nasogastric tube dysfunction (13.9%), Planned extubation (8.7%), Surgery (6.1%), Intubation (6.1%), others (MRI/bronchoscopy, etc.) 1. Incorporate ENI considerations into ICU nutritional protocols
2. Optimize diagnostic procedure scheduling to reduce unplanned ENI
3. Strengthen nasogastric tube management to minimize dysfunction
4. Adopt reduced fasting protocols to shorten interruption duration
Morgan et al. (33) 100 Unreported Gastric/intestinal route Continuous infusion Serum albumin, serum prealbumin Surgery (27%), diagnostic procedures (15%), GI intolerance (11%), EN tube issues (8%) 1. Precise timing for stopping/restarting EN before/after procedures
2. Increase jejunostomy/nasojejunal tube use
3. Aggressive prokinetic use for GI intolerance
Daphnee et al. (23) 100 Unreported Gastric route Continuous infusion / 1. In-CCU procedures (55.9%): Ventilation-related (40.25%), bedside procedures (5.48%), etc.; 2. GI symptoms (24.03%): Nasogastric aspiration (15.28%), diarrhea/vomiting (3.50%), etc.; 3. Out-of-CCU procedures (18.31%): Surgery (7.11%), radiology (6.76%), etc.; 4. Others (1.86%) 1. Modify feeding protocols to reduce avoidable ENI (especially for procedures inside CCU)
2. Incorporate strategies to avoid or shorten ENI duration for CCU procedures into clinical practice guidelines
3. Standardize the management of GI symptoms during EN to minimize prolonged interruptions
4. Strengthen coordination for procedures outside CCU to reduce unnecessary feeding cessation
Passier et al. (46) 90.24 Unreported Gastric/intestinal route Unreported / Planned procedure-related (94.4%), unplanned procedure-related (5.6%), ICU departure only (11.1%), unnecessary interruption (23%), no documented order (31%) 1. Adhere to guidelines promoting short cessation periods
2. Clarify which procedures truly require EN cessation via interdisciplinary agreement
3. Eliminate the “fast from midnight” approach; restart EN promptly at pre-cessation rate after procedures
4. Standardize documentation of EN cessation orders
5. Minimize postponed or cancelled procedures
Saran et al. (35) 11.24 Unreported Gastric/intestinal route Continuous infusion / High GRV (main cause), abdominal distension (secondary cause), vomiting (secondary cause) 1. Use bedside feeding protocols
2. Optimize HOB elevation
3. Early EN initiation
Onuk et al. (26) 100 Unreported Gastric/intestinal route Unreported Radiological procedures (27.2%), EN tube malfunction (pull-out/clogging/reinsertion) (14.7%), surgical procedures (11.1%), hemodynamic instability (9.6%), airway procedures (6.3%), high GRV (>300 mL) (5.7%), others (vomiting/GI bleeding, etc.) 1. Optimize radiological procedure scheduling to reduce ENI frequency
2. Strengthen feeding tube fixation and maintenance to prevent malfunctions
3. Standardize management of high gastric residual volume and feeding intolerance
4. Develop protocols to minimize ENI duration and compensate for nutritional deficits
Shankar et al. (34) 20.13 Unreported Gastric/intestinal route Continuous infusion / High GRV (>250 mL) (14.6%), GI bleeding (2.3%), Gastroparesis (2.3%), Nausea/vomiting (2.3%) 1. Routine initiate EN within 6 h of ICU admission
2. Strengthen daily monitoring of calorie/protein deficits
3. Standardize EN interruption criteria
Williams et al. (48) 15.45 Unreported Gastric/intestinal route Continuous infusion / 907 episodes pre-intervention vs. 662 post: extubation prep/airway management (38.81% → 41.39%), procedure-related (25.47% → 28.70%), GI issues (14.22% → 9.82%, p < 0.01), EN delivery system issues (8.49% → 7.85%) 1. Develop revised EN flow diagram for GRV management 2. Train EN Champions to promote protocol adherence 3. Provide formal and informal education on reducing unnecessary interruptions 4. Avoid fasting for procedures unless necessary
Rice et al. (50) 94.55 Unreported Gastric route Continuous infusion / Procedures (bedside/OR) (41%), no documented reason (21%), planned extubation (15%), hemodynamic instability/shock (6%), GI intolerance (9%), EN tube issues (3%), others (bath/transfer, 2% each) 1. Implement standardized enteral feeding protocols to promote early initiation and rapid advancement to target rates
2. Standardize management of gastrointestinal intolerances (e.g., tolerate gastric residuals up to 300 mL before interruption)
3. Improve documentation of reasons for feeding interruptions
4. Train medical staff on protocol implementation to ensure consistent practice
Wang and Li (16) 57.14 Continuous pumping: Interruption time > 1 h; Intermittent injection: 3 times daily, 30 min each time, but failed to obtain expected nutrition within 30 min Gastric route Continuous infusion / Independent risk factors (OR): Mechanical ventilation (synchronized intermittent) (2.305), acid suppressant use (2.875), antibiotics ≥2 types (2.732), mild hypothermia (2.703) /
Yip et al. (31) 79.22 ≥1 h Gastric route Continuous infusion / Procedures (45.1%), High GRV (38.0%), Diarrhea (8.4%), Nasogastric tube placement difficulty (5.6%) 1. Develop standardized enteral feeding protocols
2. Rationalize GRV management
3. Shorten fasting time before procedures
Zheng et al. (13) 100 Unreported Gastric route Continuous infusion / Abdominal distension (38.1%), gastric retention (26.4%), medical procedures/exams (17.3%), vomiting (11.4%), GI bleeding (9.2%), EN tube dysfunction (5.8%), hemodynamic instability (4.3%), abdominal pain (1.4%) 1. Pay close attention to the observation of gastrointestinal tolerance in patients using norepinephrine, propofol, and remifentanil
2. Take preventive measures to avoid complications such as aspiration pneumonia
3. Consider adding parenteral nutrition therapy based on the patient’s specific clinical conditions
Lee et al. (47) 100 Unreported Unreported Intermittent feeding Respiratory procedures (27.1%), planned procedure not executed post-fasting (16.9%), unknown reason (12.7%), radiological procedures (11.4%), inappropriate reasons (7.8%), GI bleeding (6.9%), others (OR/bedside procedures, etc.) 1. Implement evidence-based feeding protocols supervised by a nutrition support team
2. Revise feeding protocols based on latest research findings
3. Provide regular staff training on feeding guidelines
4. Minimize avoidable interruptions (e.g., standardize fasting time before procedures)
Zuo et al. (12) 100 ≥10 min Gastric/intestinal route Continuous infusion / Out-of-ward exams (CT/MRI) (33%), GI intolerance (15%), medical procedures (13%), unknown causes (11%), basic care (10%), pipeline factors (6%), airway operations (4%), CRRT-related (4%), surgery/prep (3%) 1. Proactively use enteral nutrition tolerance assessment and management tools, and conduct hierarchical treatment for feeding intolerance symptoms
2. Establish an evidence-based ENI prevention and management plan through group discussions and expert consultations
3. Adopt volume-based feeding (VBF) protocol: Adjust the infusion rate according to remaining time and intake when restarting EN after interruption
4. Strengthen multidisciplinary cooperation and nutrition knowledge training to improve medical staff’s cognition of ENI
5. Formulate targeted training goals for nursing staff at different levels to enhance their ENI management awareness and execution ability
6. Resume EN in a timely manner after clinical operations to avoid prolonged interruption