Effectiveness of continuous enteral nutrition versus intermittent enteral nutrition in intensive care patients: a systematic review

Martínez, Rosa Aguilera; Ortega, Emília Ramis; Munuera, Concha Carratalá; Medina, José Manuel Fernández; Saiz-Vinuesa, M.D.; Barrado-Narvión, Mª Jesús

doi:10.11124/jbisrir-2014-1129

Cited by 16 publications

(13 citation statements)

References 24 publications

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“…Tavares et al [78] in an observational study found that continuous feeding reached the target faster, but no difference in gastrointestinal symptoms was observed between the groups. A systematic review [80] did not detect an advantage of one technique but bolus administration was associated with a lower aspiration rate and better calorie achievement. However, heterogeneity of the studies decreased the strength of the recommendation.…”

Section: Commentarymentioning

confidence: 93%

ESPEN guideline on clinical nutrition in the intensive care unit

et al. 2019

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s u m m a r yFollowing the new ESPEN Standard Operating Procedures, the previous guidelines to provide best medical nutritional therapy to critically ill patients have been updated. These guidelines define who are the patients at risk, how to assess nutritional status of an ICU patient, how to define the amount of energy to provide, the route to choose and how to adapt according to various clinical conditions. When to start and how to progress in the administration of adequate provision of nutrients is also described. The best determination of amount and nature of carbohydrates, fat and protein are suggested. Special attention is given to glutamine and omega-3 fatty acids. Particular conditions frequently observed in intensive care such as patients with dysphagia, frail patients, multiple trauma patients, abdominal surgery, sepsis, and obesity are discussed to guide the practitioner toward the best evidence based therapy. Monitoring of this nutritional therapy is discussed in a separate document.

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Section: Commentarymentioning

confidence: 93%

ESPEN guideline on clinical nutrition in the intensive care unit

et al. 2019

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“…In a new review comparing continuous and intermittent enteral nutrition in the ICU in terms of nutritional status, patient tolerance and complications, the authors reported insufficient evidence to support one method over the other [19]. Another study comparing continuous and bolus enteral nutrition in the ICU reported that there was no significant difference between the groups in terms of occurrence of aspiration, high gastric residual volume, vomiting, and diarrhea [16].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the effects of continuous versus intermittent enteral feeding on plasma leptin and ghrelin levels in Intensive Care Units

et al. 2017

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Objective: The aim of this prospective randomized trial is to verify whether there is an association between the methods of administration of enteral nutrition and the leptin and ghrelin hormones, which have a major role in the regulation of energy metabolism. Methods: This study enrolled 38 enteral-fed patients aged 18 to 85 in the Intensive Care Unit. The patients were prospectively randomized to receive either continuous infusion (n=19) or intermittent feeding (n=18) of enteral nutrition. In addition to routine biochemical assays, blood samples were taken from the patients for leptin and ghrelin analyses on the 1th, 7th, and 14th days of enteral nutrition. Results: There was no statistically significant difference between the groups regarding descriptive statistics and categorical variables such as underlying diseases, complications, steroid use and others (p>0.05). The decrease in the number of white blood cells and in creatinine and C-reactive protein levels over time were statistically significant (p=0.010, p=0.026, p<0.001 respectively). There was no statistically significant difference between the groups with respect to leptin and ghrelin levels (p=0.982 and p=0.054). Leptin levels did not change over time; however, the ghrelin levels of both groups were significantly higher on the 7th and 14th days than on the first day of analysis (p=0.003). Conclusion: This study revealed that both continuous and intermittent enteral nutrition feeding regimens were well tolerated in Intensive Care Unit patients showing minor complications. The method of administration of enteral nutrition alone did not affect the leptin and ghrelin levels. Randomized controlled large cohort trials are needed to to compare intermittent and continuous enteral nutrition to determine which one is more adaptable to diurnal patterns of secretion metabolic hormones.

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“…According to the recent European Society of Parenteral and Enteral Nutrition (ESPEN) guideline on clinical nutrition in the ICU [26], continuous rather than bolus EN is preferred because it causes less diarrhea, but there is no difference in other outcomes. Another systematic review showed that bolus feeding is associated with lower aspiration rate and better calorie attainment [27]. It also provides a greater stimulus for protein synthesis [28].…”

Section: Study Interventionsmentioning

confidence: 99%

Effects of synbiotic supplementation on energy and macronutrients homeostasis and muscle wasting of critical care patients: study protocol and a review of previous studies

Seifi

Safarian

Nematy

et al. 2020

Trials

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Background: An extreme and persistent dysbiosis occurs among critically ill patients, regardless of the heterogeneity of disease. Dysbiosis in critically ill patients may make them prone to hospital-acquired infections, sepsis, multi-organ failure (MOF), energy homeostasis disturbance, muscle wasting, and cachexia. Modulation of gut microbiota through synbiotics can be considered as a potential treatment for muscle wasting and macronutrient homeostasis disturbances.Methods: This is a prospective, single-center, double-blind, parallel randomized controlled trial with the aim to evaluate the effects of synbiotic supplementation on energy and macronutrient homeostasis and muscle wasting in critically ill patients. A total of 40 hemodynamically stable, adult, critically ill patients who receive enteral nutrition via a nasogasteric tube (NGT) in the 24-48 h after admission to critical care will be included in this study. Eligible patients will be randomly assigned to receive Lactocare (ZistTakhmir) capsules 500 mg every 12 h or a placebo capsule, which contains only the sterile maize starch and is similar to synbiotic capsules for 14 days. The synbiotic and placebo capsules will be given through the nasogastric tube, separately from gavage, after feeding. Discussion: Gut microbiota modulation through synbiotics is proposed to improve clinical prognosis and reduce infectious complications, ventilator dependency, and length of ICU stay by improving energy and macronutrient homeostasis and reducing muscle protein catabolism.

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Effectiveness of continuous enteral nutrition versus intermittent enteral nutrition in intensive care patients: a systematic review

Cited by 16 publications

References 24 publications

ESPEN guideline on clinical nutrition in the intensive care unit

ESPEN guideline on clinical nutrition in the intensive care unit

Comparison of the effects of continuous versus intermittent enteral feeding on plasma leptin and ghrelin levels in Intensive Care Units

Effects of synbiotic supplementation on energy and macronutrients homeostasis and muscle wasting of critical care patients: study protocol and a review of previous studies

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