Enteral nutrition is associated with 30% to 80% incidence of hyperglycemia in critically ill patientsEnteral Nutrition Linked to High Blood Sugar in ICU Patients

BackgroundHyperglycemia is a common complication in critically ill patients receiving enteral nutrition (EN). This review synthesizes evidence on its mechanisms, epidemiology, clinical implications, and nursing management to support precision glycemic care.MethodsA systematic literature search identified 45 eligible studies, including randomized trials, retrospective studies, reviews, guidelines, and expert consensus statements. Given the lack of a universally accepted definition, enteral nutrition-related hyperglycemia was pragmatically defined as blood glucose ≥7.8 mmol/L occurring within 24−72 h after initiation of enteral nutrition.ResultsReported incidence varies widely, from approximately 30−47% in general ICU populations to 60−80% following cardiac surgery, reflecting differences in definitions, patient characteristics, timing, and nutritional protocols. Based on thematic integration of existing evidence, we propose a six-level conceptual cascade framework, linking metabolic vulnerability, stress-hormone activation, exogenous substrate load, enteroinsular axis dysfunction, inflammation-mediated insulin resistance, and microbiota dysbiosis. Corresponding nursing strategies include diabetes-specific formulas, optimized feeding regimens, continuous glucose monitoring, and individualized insulin protocols within multidisciplinary care. These strategies may improve glycemic control; however, evidence for clinical outcome benefits remains limited and heterogeneous.ConclusionFurther prospective studies are needed to validate the model and refine precision nursing strategies.