Controversies and Misconceptions in Intensive Care Unit Nutrition

Hooper, Michael H.; Marik, Paul E.

doi:10.1016/j.ccm.2015.05.013

Cited by 22 publications

(21 citation statements)

References 89 publications

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“…Many of these studies have found no significant differences between bolus and continuous tube feeding in key enteral feeding outcomes, including nutritional intake, safety and tolerance (26,27,(38)(39)(40) . Some of the research in fact argues in favour of bolus tube feeding over continuous tube feeding from a biological standpoint, stating that continuous tube feeding is incompatible with human physiology as it does not stimulate the gastrointestinal tract into a fed response (13,14) . Studies by Stratton et al have demonstrated that bolus tube feeding elicits a greater satiating effect and a hormone response more typical of the fed state compared with continuous tube feeding (19,20) , which would support the current survey's finding that many patients use bolus tube feeding to mimic mealtimes.…”

Section: Discussionmentioning

confidence: 99%

“…Bolus tube feeding, however, is the administration of a predetermined volume of feed at specified intervals over a relatively short period of time and is typically delivered via syringe (with or without the use of a plunger) or in some cases via a feeding pump set to a high rate (10) . However, varying volumes (200-750 ml) and feeding periods (5-45 min) have previously been used to define bolus tube feeding (10)(11)(12)(13)(14) .…”

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confidence: 99%

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A survey of bolus tube feeding prevalence and practice in adult patients requiring home enteral tube feeding

et al. 2019

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Anecdotal evidence suggests the use of bolus tube feeding is increasing in the long-term home enteral tube feed (HETF) patients. A crosssectional survey to assess the prevalence of bolus tube feeding and to characterise these patients was undertaken. Dietitians from ten centres across the UK collected data on all adult HETF patients on the dietetic caseload receiving bolus tube feeding (n 604, 60 % male, age 58 years). Demographic data, reasons for tube and bolus feeding, tube and equipment types, feeding method and patients' complete tube feeding regimens were recorded. Over a third of patients receiving HETF used bolus feeding (37 %). Patients were long-term tube fed (4·1 years tube feeding, 3·5 years bolus tube feeding), living at home (71 %) and sedentary (70 %). The majority were head and neck cancer patients (22 %) who were significantly more active (79 %) and lived at home (97 %), while those with cerebral palsy (12 %) were typically younger (age 31 years) but sedentary (94 %). Most patients used bolus feeding as their sole feeding method (46 %), because it was quick and easy to use, as a top-up to oral diet or to mimic mealtimes. Importantly, oral nutritional supplements (ONS) were used for bolus feeding in 85 % of patients, with 51 % of these being compact-style ONS (2·4 kcal (10·0 kJ)/ml, 125 ml). This survey shows that bolus tube feeding is common among UK HETF patients, is used by a wide variety of patient groups and can be adapted to meet the needs of a variety of patients, clinical conditions, nutritional requirements and lifestyles.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

A survey of bolus tube feeding prevalence and practice in adult patients requiring home enteral tube feeding

et al. 2019

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“…33,34 In reality, no mammalian species eats throughout a 24-hour period, and there may be an underappreciated metabolic implication to this standard practice in the ICU. 35 Continuous enteral feeding may also inadvertently predispose patients to hypoglycemia due to interruptions (which are sometimes prolonged and frequent) related to procedures and tests in the ICU. Further research is needed to define the best approach to providing sufficient nutrition during critical illness.…”

Section: The Relationship Between Enteral Feeding and Hyperglycemiamentioning

confidence: 99%

Metabolic Management during Critical Illness: Glycemic Control in the ICU

Honiden

Inzucchi

2015

Semin Respir Crit Care Med

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Hyperglycemia is a commonly encountered metabolic derangement in the ICU. Important cellular pathways, such as those related to oxidant stress, immunity, and cellular homeostasis, can become deranged with prolonged and uncontrolled hyperglycemia. There is additionally a complex interplay between nutritional status, ambient glucose concentrations, and protein catabolism. While the nuances of glucose management in the ICU have been debated, results from landmark studies support the notion that for most critically ill patients moderate glycemic control is appropriate, as reflected by recent guidelines. Beyond the target population and optimal glucose range, additional factors such as hypoglycemia and glucose variability are important metrics to follow. In this regard, new technologies such as continuous glucose sensors may help alleviate the risks associated with such glucose fluctuations in the ICU. In this review, we will explore the impact of hyperglycemia upon critical cellular pathways and how nutrition provided in the ICU affects blood glucose. Additionally, important clinical trials to date will be summarized. A practical and comprehensive approach to glucose management in the ICU will be outlined, touching upon important issues such as glucose variability, target population, and hypoglycemia.

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“…(9) Whey protein is digested faster and stimulates postprandial amino acid accretion more effectively. (9)(10)(11) Regarding MPS, the vital role of the essential amino acid leucine, naturally available in relevant amounts when administering whey protein (1.13 g leucine/100 ml) (12) has been described in prior investigations. (10,13,14) In 2015, Marik (1) suggested feeding whey-based nutrition formulas to critically ill patients, and in 2017, Heyland et al (15) proposed aiming for high-protein nutrition targets (minimum 1.2-1.5 g protein/kg bodyweight(BW)/24 hours, maximum 2.0-2.5 g protein/kg BW/24 hours) in ICU setting.…”

Section: Introductionmentioning

confidence: 99%

Protein delivery in intermittent and continuous enteral nutrition with a protein-rich formula in critically ill patients - A protocol for the prospective randomised controlled proof-of-concept Protein Bolus Nutrition (Pro BoNo) study

Reinhold

Yeginsoy

Hollinger

et al. 2020

Preprint

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Background Critically ill patients rapidly develop muscle wasting resulting in sarcopenia, long-term disability and higher mortality. Bolus nutrition (30-60 min period), while having a similar incidence of aspiration as continuous feeding, seems to provide metabolic benefits through increased muscle protein synthesis due to higher leucine peaks. To date, clinical evidence on achievement of nutritional goals and influence of bolus nutrition on skeletal muscle metabolism in ICU patients is lacking. The aim of the Pro BoNo study (Protein Bolus Nutrition) is to compare intermittent and continuous enteral feeding with a specific high-protein formula. We hypothesise that target quantity of protein is reached earlier (within 36 hours) by an intermittent feeding protocol with a favourable influence on muscle protein synthesis.Methods Pro BoNo is a prospective randomised controlled study aiming to compare the impact of intermittent and continuous enteral feeding on preventing muscle wasting in 60 critically ill patients recruited during the first 48 hours after ICU admission. The primary outcome measure is the time until the daily protein target (≥1.5 g protein/kg bodyweight/24h) is achieved. Secondary outcome measures include tolerance of enteral feeding and evolution of glucose, urea and IGF-1. Ultrasound and muscle biopsy of the quadriceps will be performed.Discussion The Basel Pro BoNo study aims to collect innovative data on the effect of intermittent enteral feeding of critically ill patients on muscle wasting.Trial registration ClinicalTrials.gov Identifier: NCT03587870, registered July 16, 2018. Swiss National Clinical Trial Portal identifier: SNCTP000003234, last updated July 24, 2019.

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Controversies and Misconceptions in Intensive Care Unit Nutrition

Cited by 22 publications

References 89 publications

A survey of bolus tube feeding prevalence and practice in adult patients requiring home enteral tube feeding

A survey of bolus tube feeding prevalence and practice in adult patients requiring home enteral tube feeding

Metabolic Management during Critical Illness: Glycemic Control in the ICU

Protein delivery in intermittent and continuous enteral nutrition with a protein-rich formula in critically ill patients - A protocol for the prospective randomised controlled proof-of-concept Protein Bolus Nutrition (Pro BoNo) study

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