Enteral nutrition interruption in critically ill patients: a systematic review and meta-analysis of prevalence, causes, and clinical outcomes

Abstract

Introduction Enteral nutrition interruption (ENI) is common in critically ill patients and may compromise nutritional delivery, but its prevalence, causes, and clinical consequences remain uncertain. This systematic review and meta-analysis synthesized evidence on ENI prevalence, contributing factors, clinical outcomes, and potential interventions. Methods PubMed, Embase, CINAHL, Web of Science, Cochrane Library, CNKI, and WanFang Data were searched from inception through December 2025. Studies of critically ill adults receiving enteral nutrition were eligible. The review followed PRISMA guidance and was registered in PROSPERO (CRD420251266654). Random-effects models, subgroup analyses, sensitivity analyses, and GRADE assessments were performed. Results Forty-one studies involving 8,260 critically ill patients were included. Crude ENI prevalence ranged from 11.2% to 100%, with a median of 68.5% (IQR, 57.1%-96.6%). The estimated pooled prevalence was 79.2%, although heterogeneity was extreme (I2 = 99%) and publication bias was evident (Egger’s test, p < 0.001). Common causes included airway management, radiological or imaging procedures, gastrointestinal intolerance, and surgical procedures or preparation. ENI was associated with reduced energy adequacy (mean difference, -4.21 percentage points; 95% CI, –7.71 to –0.71; p = 0.02). No statistically significant association was observed with ICU length of stay (mean difference, –0.41 days; 95% CI, –2.05 to 1.23; p = 0.62). Short-term mortality was not statistically significantly associated with ENI (risk ratio, 1.86; 95% CI, 0.67–5.11), but the estimate was imprecise and heterogeneous (I2 = 88%). Discussion ENI appears common and is predominantly procedure-related. It is associated with reduced energy adequacy, whereas its effects on ICU length of stay and short-term mortality remain uncertain because of inconsistent ENI definitions, substantial heterogeneity, publication bias, and limited outcome data. Standardized definitions, shorter peri-procedural fasting, improved gastrointestinal management, and multidisciplinary nutrition protocols may reduce avoidable interruptions. High-quality prospective studies and randomized trials are needed. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251266654.