Comparison of the Effect of Enteral Feeding through the Bolus and Continuous Methods on Serum Phosphorus and Glucose Levels in Patients with Mechanical Ventilation: A Randomized Clinical Trial

Abstract

Introduction. Patients who are under mechanical ventilation in intensive care units need to have nutritional support. Also, feeding methods affect serum phosphorus and glucose levels, which are very important in weaning patients off the ventilator. Thus, this study is to compare the effects of both bolus and continuous enteral feeding methods on serum phosphorus and glucose levels in patients with mechanical ventilation. Methods. In this clinical trial study, 34 patients in the intensive care unit of Imam Khomeini Hospital affiliated to the Tehran University of Medical Sciences satisfied inclusion criteria and were randomly divided into control and intervention groups. Sampling was done between October and February 2018. The intervention group received continuous enteral feeding for one week, and the control group received nutrition by the bolus method. The blood glucose level was measured every six hours, and the serum phosphorus level was recorded at the beginning and the end of the intervention, based on the data entry form with respect to all ethical considerations. Data analysis was done by SPSS-20 software. Results. The serum phosphorus level was significantly increased in the intervention group (P=0.004) and in the control group (P<0.001) and was compared with the previous intervention. No significant difference was found between the intervention and control groups before and after the intervention (P=0.22) and also one week after the intervention (P=0.14). There was also no significant difference between the glucose levels from day 1 to day 7 in the control group (P=0.33) and the intervention group (P=0.086). Discussion. Nutritional support in both bolus and continuous methods increased the serum phosphorus level. It indicates the importance of the nutritional method in controlling the phosphorus level in critically ill patients. However, there was no difference between the effects of dietary methods on blood glucose control.

Intragastric prepyloric enteral nutrition, bolus vs continuous in the adult patient: A systematic review and meta‐analysis

“…A problem related to the use of the bolus method could be a complicated glycemic control caused by the administration of more fluctuating nutrients. Bolus feeding, however, does not appear to cause an increase in glycemic variability or insulin administration compared with continuous feeding, as reported in an RCT of 34 patients 33 …”

“…One study 33 with 34 patients assessed the glucose level in the two feeding groups. The data collected showed no differences between the two groups in glucose levels during the days of continuous enteral feeding ( P = 0.33) and bolus feeding ( P = 0.86).…”

“…One study 30 was a nonrandomized controlled study at a high risk of selection bias. The remaining three studies [31][32][33] did not show details of the randomization process and were identified as having an unclear risk.…”

Pemberian Nutrisi Enteral sebagai Kontrol Glikemik pada Pasien Kritis di Unit Perawatan Intensif

“…Serta pada penelitian Maurya et al (2011) dengan metode bolus feeding dilakukan dengan menggunakan spuit 50 mL secara manual sebanyak 6 kali pemberian berselang 3 jam dalam waktu 18 jam dan jeda istirahat malam selama 6 jam. Ataupun pada penelitian Seyyedi et al, (2020) bolus feeding diberikan melalui nasogastric per 3 jam. Keefektifan dari berbagai metode tersebut dalam upaya menjaga keseimbangan kadar glukosa darah atau kontrol glikemik telah dirangkum dalam tinjauan sistematis ini.…”

“…Penelitian yang dilakukan Seyyedi et al, (2020); Evans et al, (2016) membandingkan antara metode pemberian nutrisi bolus dan continuous, menunjukkan bahwa tidak ada perbedaan signifikan yang ditemukan sampai dengan satu minggu setelah intervensi antara kedua kelompok sebelum dan sesudah intervensi (Seyyedi et al, 2020). Serta tidak ada perbedaan yang relevan secara klinis dalam variabilitas glikemik, penggunaan insulin, volume tube feeding atau asupan kalori antara kelompok bolus dan continuous (Evans et al, 2016).…”