Advancements in research on feeding intolerance to enteral nutrition in neurocritical patients undergoing sedation and analgesia.

In the Neurocritical Care Unit (NICU), deep sedation and analgesia are essential for managing critically ill patients to control intracranial pressure and reduce brain stress. However, these drugs-particularly opioids and benzodiazepines-significantly impair gastrointestinal motility and barrier function, increasing the risk of feeding intolerance (FI) to 46.38-62.0% in this population (1). FI manifests as elevated gastric residual volume, abdominal distension, vomiting, or failure to meet enteral nutrition targets within 72 h (2), and is associated with higher infection rates, prolonged hospital stay, increased medical costs, and worse neurological and overall prognosis (3). Therefore, clarifying the pathophysiological mechanisms, risk factors, assessment methods, and management strategies of FI in the context of sedation and analgesia is vital for developing standardized, individualized nutritional support plans for neurocritical patients. This review systematically elaborates the "neuro-sedation-gut" triad mechanism, stratifies population-specific risk factors graded by the GRADE system, integrates precise multimodal assessment tools, and proposes an algorithmic management pathway aligned with 2023-2024 ESPEN/ASPEN guidelines, to provide targeted theoretical and practical references for neurocritical care practice.