Interruptions of enteral nutrition in intensive care units: mechanisms, clinical impacts, and precision nursing interventions-a scoping review.

Background: Enteral nutrition (EN) is the preferred nutritional support for critically ill patients in intensive care units (ICU). Despite its benefits, enteral nutrition interruption (ENI) occurs frequently in ICU practice and may contribute to inadequate nutrient delivery, which has been associated with poorer nutritional status and potentially unfavorable clinical outcomes. A consolidated synthesis of its mechanisms, clinical impact, and precision nursing interventions remains limited. Objective: This scoping review aimed to summarize the mechanisms underlying ENI, evaluate its impact on ICU patient outcomes, and identify nurse led precision interventions to optimize nutritional support. Methods: This scoping review followed JBI methodology, the Arksey and O'Malley framework, and PRISMA ScR standards. Using the PCC structure of ICU patients, ENI, and nursing practice, a three stage search was conducted in major databases up to April 2025. Eligible evidence included experimental, observational, as well as guidelines and implementation projects. Study selection and data extraction were independently completed by two reviewers, with findings synthesized narratively. Results: 29 studies from diverse ICU settings were included. Procedural and diagnostic activities accounted for 63.4 percent of ENI, followed by gastrointestinal intolerance at 19.2 percent, tube related complications at 9.3 percent, and hemodynamic instability at 3.9 percent, while patient and provider related factors contributed approximately 33 percent. ENI was associated with nutritional inadequacy in 38-78 percent of patients and with impaired intestinal barrier function and increased infection risk. Experiencing three or more interruptions has been associated with a higher mortality risk. Precision nursing interventions, including standardized feeding protocols, continuous infusion, reduced gastric residual volume monitoring, perioperative nutritional optimization, and prokinetic agent use, reduced interruption frequency and duration and improved energy and protein target achievement from 26.9 and 18.6 percent to 57.0 and 57.4 percent. Conclusion: Enteral nutrition interruption is common in ICU practice and has been associated with inadequate nutritional delivery and potentially adverse outcomes in critically ill patients. Nurse-led precision interventions may help reduce interruptions and improve nutritional adequacy, although their effects on broader patient-centered outcomes require further study. Future efforts should prioritize standardized protocols, multidisciplinary collaboration, and intelligent monitoring to advance evidence informed nutritional nursing practice.