{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T14:39:24Z","timestamp":1769956764351,"version":"3.49.0"},"reference-count":52,"publisher":"AACN Publishing","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Enteral feeding intolerance, a type of gastrointestinal dysfunction, is common in adults receiving mechanical ventilation, yet its definition and clinical assessment remain variable. If untreated, this syndrome may lead to underfeeding, which is associated with worse patient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe what is known about enteral feeding intolerance, including who is at risk, clinical symptoms, identifying measures used, treatment, and clinical implications for nursing practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Enteral feeding intolerance is identified by (1) changes in gastrointestinal function, (2) high gastric residual volume, and\/or (3) inadequate delivery of enteral nutrition. A combination of gastrointestinal symptoms and high gastric residual volume is generally used to diagnose the condition. The most common symptoms are vomiting, abdominal distention, absence of bowel sounds or flatus, and diarrhea. Administration of promotility agents and reduction of the enteral formula rate are most often used to reduce the effects of enteral feeding intolerance until it resolves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Many gastrointestinal assessment findings are subjective and lack precision. Although the routine measurement of gastric residual volume is no longer standard practice, it is indicated in patients at risk for enteral feeding intolerance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Nurses should become familiar with how to assess for and treat enteral feeding intolerance, as well as rule out other common gastrointestinal complications. Clinical biomarkers are needed to objectively identify enteral feeding intolerance in critically ill patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4037\/ccn2026884","type":"journal-article","created":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:03:53Z","timestamp":1769904233000},"page":"23-31","source":"Crossref","is-referenced-by-count":0,"title":["Enteral Feeding Intolerance in Adult Patients Receiving Mechanical Ventilation: A Comprehensive Review"],"prefix":"10.4037","volume":"46","author":[{"given":"Annette M.","family":"Bourgault","sequence":"first","affiliation":[{"name":"Annette M. Bourgault is an associate professor, University of Central Florida, College of Nursing, Orlando, Florida, and the Editor in Chief of Critical Care Nurse."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer Carroll","family":"Simmons","sequence":"additional","affiliation":[{"name":"Jennifer Carroll Simmons was a PhD student, University of Central Florida, College of Nursing."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Powers","sequence":"additional","affiliation":[{"name":"Jan Powers is the director of nursing research and evidence-based practice, professional practice department, Parkview Health System, Fort Wayne, Indiana."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lillian","family":"Aguirre","sequence":"additional","affiliation":[{"name":"Lillian Aguirre is a clinical nurse specialist, Surgical and Perioperative Services, Orlando Regional Medical Center, a part of Orlando Health, Orlando, Florida."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary Lou","family":"Sole","sequence":"additional","affiliation":[{"name":"Mary Lou Sole is a dean and professor emerita, College of Nursing, University of Central Florida."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2471","reference":[{"issue":"1","key":"2026013119034826700_b1-0460023","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1097\/CCM.0000000000004712","article-title":"Incidence, risk factors, and clinical consequence of enteral feeding intolerance in the mechanically ventilated critically ill: an analysis of a multicenter, multiyear database","volume":"49","author":"Heyland","year":"2021","journal-title":"Crit Care Med"},{"key":"2026013119034826700_b2-0460023","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.clnesp.2022.04.014","article-title":"A systematic review of the definitions and prevalence of feeding intolerance in critically ill adults","volume":"49","author":"Jenkins","year":"2022","journal-title":"Clin Nutr ESPEN"},{"issue":"1","key":"2026013119034826700_b3-0460023","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1002\/ncp.10599","article-title":"Enteral feeding intolerance: updates in definitions and pathophysiology","volume":"36","author":"Reintam Blaser","year":"2021","journal-title":"Nutr Clin Pract"},{"issue":"1","key":"2026013119034826700_b4-0460023","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1186\/s13054-020-02889-4","article-title":"Gastrointestinal dysfunction in the critically ill: a systematic scoping review and research agenda proposed by the Section of Metabolism, Endocrinology and Nutrition of the European Society of Intensive Care Medicine","volume":"24","author":"Reintam Blaser","year":"2020","journal-title":"Crit Care"},{"issue":"1","key":"2026013119034826700_b5-0460023","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1186\/s13054-024-05192-8","article-title":"Core outcome set of daily monitoring of gastrointestinal function in adult critically ill patients: a modified Delphi consensus process (COSMOGI)","volume":"28","author":"Bachmann","year":"2024","journal-title":"Crit Care"},{"issue":"2","key":"2026013119034826700_b6-0460023","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1002\/jpen.1679","article-title":"Gastrointestinal dysfunction in critical illness: a review of scoring tools","volume":"44","author":"Asrani","year":"2020","journal-title":"JPEN J Parenter Enteral Nutr"},{"issue":"1","key":"2026013119034826700_b7-0460023","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11894-019-0736-z","article-title":"Gastrointestinal dysfunction and feeding intolerance in critical illness: do we need an objective scoring system?","volume":"22","author":"McClave","year":"2020","journal-title":"Curr Gastroenterol Rep"},{"issue":"5","key":"2026013119034826700_b8-0460023","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1097\/MCO.0000000000000955","article-title":"Gastrointestinal function in critically ill patients","volume":"26","author":"Reintam Blaser","year":"2023","journal-title":"Curr Opin Clin Nutr Metab Care"},{"issue":"2","key":"2026013119034826700_b9-0460023","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1097\/MCO.0000000000000146","article-title":"Should enteral nutrition be started in the first week of critical illness?","volume":"18","author":"Martindale","year":"2015","journal-title":"Curr Opin Clin Nutr Metab Care"},{"issue":"5","key":"2026013119034826700_b10-0460023","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1164\/rccm.201907-1487OC","article-title":"Lung microbiota predict clinical outcomes in critically ill patients","volume":"201","author":"Dickson","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"issue":"4","key":"2026013119034826700_b11-0460023","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1177\/0148607114526450","article-title":"Prevalence, risk factors, clinical consequences, and treatment of enteral feed intolerance during critical illness","volume":"39","author":"Gungabissoon","year":"2015","journal-title":"JPEN J Parenter Enteral Nutr"},{"issue":"1","key":"2026013119034826700_b12-0460023","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1186\/s13054-016-1441-z","article-title":"The efficacy and safety of prokinetic agents in critically ill patients receiving enteral nutrition: a systematic review and meta-analysis of randomized trials","volume":"20","author":"Lewis","year":"2016","journal-title":"Crit Care"},{"issue":"5","key":"2026013119034826700_b13-0460023","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1016\/j.clnu.2014.10.006","article-title":"Comparison of different definitions of feeding intolerance: a retrospective observational study","volume":"34","author":"Reintam Blaser","year":"2015","journal-title":"Clin Nutr"},{"issue":"1","key":"2026013119034826700_b14-0460023","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s40560-023-00674-3","article-title":"Different definitions of feeding intolerance and their associations with outcomes of critically ill adults receiving enteral nutrition: a systematic review and meta-analysis","volume":"11","author":"Li","year":"2023","journal-title":"J Intensive Care"},{"issue":"12","key":"2026013119034826700_b15-0460023","doi-asserted-by":"publisher","first-page":"2705","DOI":"10.3390\/nu15122705","article-title":"Using machine-learning to assess the prognostic value of early enteral feeding intolerance in critically ill patients: a retrospective study","volume":"15","author":"Raphaeli","year":"2023","journal-title":"Nutrients"},{"issue":"1","key":"2026013119034826700_b16-0460023","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1186\/s13054-019-2388-7","article-title":"Safety and efficacy of volume-based feeding in critically ill, mechanically ventilated adults using the \u2018Protein & Energy Requirements Fed for Every Critically ill patient every Time\u2019 (PERFECT) protocol: a before-and-after study","volume":"23","author":"Brierley-Hobson","year":"2019","journal-title":"Crit Care"},{"issue":"3","key":"2026013119034826700_b17-0460023","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1007\/s00134-011-2459-y","article-title":"Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems","volume":"38","author":"Reintam Blaser","year":"2012","journal-title":"Intensive Care Med"},{"issue":"6","key":"2026013119034826700_b18-0460023","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1002\/jpen.1469","article-title":"Incidence and effects of feeding intolerance in trauma patients","volume":"43","author":"Virani","year":"2019","journal-title":"JPEN J Parenter Enteral Nutr"},{"issue":"4","key":"2026013119034826700_b19-0460023","doi-asserted-by":"publisher","first-page":"379","DOI":"10.5603\/AIT.a2015.0022","article-title":"Abdominal signs and symptoms in intensive care patients","volume":"47","author":"Reintam Blaser","year":"2015","journal-title":"Anaesthesiol Intensive Ther"},{"issue":"1","key":"2026013119034826700_b20-0460023","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1097\/CCM.0b013e318192678e","article-title":"Can the abdominal perimeter be used as an accurate estimation of intra-abdominal pressure?","volume":"37","author":"Malbrain","year":"2009","journal-title":"Crit Care Med"},{"issue":"11","key":"2026013119034826700_b21-0460023","doi-asserted-by":"publisher","first-page":"2616","DOI":"10.3390\/nu11112616","article-title":"Intra-abdominal pressure as a marker of enteral nutrition intolerance in critically ill patients. The PIANE Study","volume":"11","author":"Bordej\u00e9","year":"2019","journal-title":"Nutrients"},{"issue":"5","key":"2026013119034826700_b22-0460023","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1007\/s00134-013-2831-1","article-title":"Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study","volume":"39","author":"Reintam Blaser","year":"2013","journal-title":"Intensive Care Med"},{"issue":"5","key":"2026013119034826700_b23-0460023","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1007\/s00134-022-06663-8","article-title":"Diarrhea during critical illness: a multicenter cohort study","volume":"48","author":"Dionne","year":"2022","journal-title":"Intensive Care Med"},{"issue":"8","key":"2026013119034826700_b24-0460023","doi-asserted-by":"publisher","first-page":"4932","DOI":"10.1016\/j.clnu.2021.07.015","article-title":"Development of the Gastrointestinal Dysfunction Score (GIDS) for critically ill patients\u2014a prospective multicenter observational study (iSOFA study)","volume":"40","author":"Reintam Blaser","year":"2021","journal-title":"Clin Nutr"},{"issue":"3","key":"2026013119034826700_b25-0460023","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1111\/nmo.12738","article-title":"Bristol Stool Form Scale reliability and agreement decreases when determining Rome III stool form designations","volume":"28","author":"Chumpitazi","year":"2016","journal-title":"Neurogastroenterol Motil"},{"issue":"2","key":"2026013119034826700_b26-0460023","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1093\/ajcn\/nqac113","article-title":"Gastrointestinal dysfunction during enteral nutrition delivery in intensive care unit (ICU) patients: risk factors, natural history, and clinical implications. A post-hoc analysis of The Augmented versus Routine approach to Giving Energy Trial (TARGET)","volume":"116","author":"Arunachala Murthy","year":"2022","journal-title":"Am J Clin Nutr"},{"issue":"8","key":"2026013119034826700_b27-0460023","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1097\/01.NAJ.0000767356.16777.f1","article-title":"Monitoring adult patients for intolerance to gastric tube feedings","volume":"121","author":"Metheny","year":"2021","journal-title":"Am J Nurs"},{"issue":"1","key":"2026013119034826700_b28-0460023","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.clnu.2018.08.037","article-title":"ESPEN guideline on clinical nutrition in the intensive care unit","volume":"38","author":"Singer","year":"2019","journal-title":"Clin Nutr"},{"issue":"2","key":"2026013119034826700_b29-0460023","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1097\/CCM.0000000000001525","article-title":"Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)","volume":"44","author":"Taylor","year":"2016","journal-title":"Crit Care Med"},{"issue":"2","key":"2026013119034826700_b30-0460023","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1097\/MCO.0000000000000545","article-title":"Introduction to the 2018 ESPEN guidelines on clinical nutrition in the intensive care unit: food for thought and valuable directives for clinicians!","volume":"22","author":"McClave","year":"2019","journal-title":"Curr Opin Clin Nutr Metab Care"},{"issue":"1","key":"2026013119034826700_b31-0460023","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1177\/0884533613510948","article-title":"The Canadian critical care nutrition guidelines in 2013: an update on current recommendations and implementation strategies","volume":"29","author":"Dhaliwal","year":"2014","journal-title":"Nutr Clin Pract"},{"issue":"2","key":"2026013119034826700_b32-0460023","doi-asserted-by":"crossref","first-page":"314","DOI":"10.15171\/apb.2019.037","article-title":"Identifying critically ill patients at risk of malnutrition and underfeeding: a prospective study at an academic hospital","volume":"9","author":"Osooli","year":"2019","journal-title":"Adv Pharm Bull"},{"issue":"2","key":"2026013119034826700_b33-0460023","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1097\/DCC.0000000000000685","article-title":"Assessment for enteral feeding intolerance by critical care nurses: a national survey","volume":"44","author":"Powers","year":"2025","journal-title":"Dimens Crit Care Nurs"},{"issue":"10","key":"2026013119034826700_b34-0460023","doi-asserted-by":"publisher","first-page":"16113","DOI":"10.1038\/nmicrobiol.2016.113","article-title":"Enrichment of the lung microbiome with gut bacteria in sepsis and the acute respiratory distress syndrome","volume":"1","author":"Dickson","year":"2016","journal-title":"Nat Microbiol"},{"issue":"4","key":"2026013119034826700_b35-0460023","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.medin.2019.10.003","article-title":"Effect of hypocaloric versus standard enteral feeding on clinical outcomes in critically ill adults\u2014a meta-analysis of randomized controlled trials with trial sequential analysis","volume":"45","author":"Zhou","year":"2021","journal-title":"Med Intensiva (Engl Ed)"},{"issue":"3","key":"2026013119034826700_b36-0460023","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1177\/0148607113486482","article-title":"Intestinal microbial diversity and perioperative complications","volume":"38","author":"Ralls","year":"2014","journal-title":"JPEN J Parenter Enteral Nutr"},{"issue":"4","key":"2026013119034826700_b37-0460023","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1002\/ncp.10242","article-title":"Enteral nutrition in the mechanically ventilated patient","volume":"34","author":"Allen","year":"2019","journal-title":"Nutr Clin Pract"},{"issue":"6","key":"2026013119034826700_b38-0460023","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1016\/j.aucc.2021.10.008","article-title":"The intensivist\u2019s assessment of gastrointestinal function: a pilot study","volume":"35","author":"Asrani","year":"2022","journal-title":"Aust Crit Care"},{"issue":"19","key":"2026013119034826700_b39-0460023","doi-asserted-by":"publisher","first-page":"1240","DOI":"10.21037\/atm-20-6317","article-title":"Association between serum lactate levels and enteral feeding intolerance in septic patients treated with vasopressors: a retrospective cohort study","volume":"8","author":"Mao","year":"2020","journal-title":"Ann Transl Med"},{"issue":"1","key":"2026013119034826700_b40-0460023","doi-asserted-by":"crossref","first-page":"7","DOI":"10.2478\/jccm-2024-0007","article-title":"Feeding intolerance in critically ill patients with enteral nutrition: a meta-analysis and systematic review","volume":"10","author":"Xu","year":"2024","journal-title":"J Crit Care Med (Targu Mures)"},{"issue":"1","key":"2026013119034826700_b41-0460023","doi-asserted-by":"crossref","first-page":"32","DOI":"10.4103\/sjg.sjg_286_21","article-title":"Development and validation of a predictive model for feeding intolerance in intensive care unit patients with sepsis","volume":"28","author":"Hu","year":"2022","journal-title":"Saudi J Gastroenterol"},{"issue":"2","key":"2026013119034826700_b42-0460023","first-page":"200","article-title":"The future of artificial intelligence in clinical nutrition","volume":"27","author":"Singer","year":"2024","journal-title":"Curr Opin Clin Nutr Metab Care"},{"issue":"6","key":"2026013119034826700_b43-0460023","doi-asserted-by":"publisher","first-page":"512","DOI":"10.4037\/ajcc2008.17.6.512","article-title":"Gastric residual volume and aspiration in critically ill patients receiving gastric feedings","volume":"17","author":"Metheny","year":"2008","journal-title":"Am J Crit Care"},{"issue":"3","key":"2026013119034826700_b44-0460023","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1177\/0148607105029003192","article-title":"Effect of feeding-tube properties on residual volume measurements in tube-fed patients","volume":"29","author":"Metheny","year":"2005","journal-title":"JPEN J Parenter Enteral Nutr"},{"issue":"3","key":"2026013119034826700_b45-0460023","first-page":"125","article-title":"Measurement of gastric residual volume: state of the science","volume":"9","author":"Edwards","year":"2000","journal-title":"Medsurg Nurs"},{"issue":"1","key":"2026013119034826700_b46-0460023","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/0884533614562841","article-title":"Gastric residual volume in critically ill patients: a dead marker or still alive?","volume":"30","author":"Elke","year":"2015","journal-title":"Nutr Clin Pract"},{"issue":"2","key":"2026013119034826700_b47-0460023","first-page":"120","article-title":"The need for biomarkers to determine response to enteral nutrition during and after critical illness: an update","volume":"26","author":"Reintam Blaser","year":"2023","journal-title":"Curr Opin Clin Nutr Metab Care"},{"issue":"1","key":"2026013119034826700_b48-0460023","doi-asserted-by":"crossref","first-page":"134","DOI":"10.4266\/acc.2022.00955","article-title":"The diagnostic accuracy of ultrasonography over manual aspiration for gastric reserve volume estimation in critically ill patients","volume":"38","author":"Sharma","year":"2023","journal-title":"Acute Crit Care"},{"issue":"11","key":"2026013119034826700_b49-0460023","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1007\/s11894-019-0724-3","article-title":"Refeeding syndrome in the critically ill: a literature review and clinician\u2019s guide","volume":"21","author":"McKnight","year":"2019","journal-title":"Curr Gastroenterol Rep"},{"issue":"2","key":"2026013119034826700_b50-0460023","doi-asserted-by":"publisher","first-page":"96","DOI":"10.4037\/ccn2011958","article-title":"Turning tube feeding off while repositioning patients in bed","volume":"31","author":"Metheny","year":"2011","journal-title":"Crit Care Nurse"},{"issue":"1","key":"2026013119034826700_b51-0460023","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4103\/sjg.sjg_38_22","article-title":"Predicting enteral feeding intolerance in patients with sepsis: why and how?","volume":"28","author":"Arabi","year":"2022","journal-title":"Saudi J Gastroenterol"},{"key":"2026013119034826700_b52-0460023","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/j.clnesp.2024.07.023","article-title":"Prospective multicenter study to validate the Gastrointestinal Dysfunction Score (GIDS) in intensive care patients: study protocol for part A of the international GUTPHOS study","volume":"63","author":"Kouw","year":"2024","journal-title":"Clin Nutr ESPEN"}],"container-title":["Critical Care Nurse"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aacnjournals.org\/ccnonline\/article-pdf\/46\/1\/23\/168673\/23.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/aacnjournals.org\/ccnonline\/article-pdf\/46\/1\/23\/168673\/23.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:03:57Z","timestamp":1769904237000},"score":1,"resource":{"primary":{"URL":"https:\/\/aacnjournals.org\/ccnonline\/article\/46\/1\/23\/32933\/Enteral-Feeding-Intolerance-in-Adult-Patients"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,1]]},"references-count":52,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,2,1]]}},"URL":"https:\/\/doi.org\/10.4037\/ccn2026884","relation":{},"ISSN":["0279-5442","1940-8250"],"issn-type":[{"value":"0279-5442","type":"print"},{"value":"1940-8250","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,1]]}}}