Intermittent and Continuous Enteral Nutrition in Critically Ill Dogs: A Prospective Randomized Trial

Abstract

Background: Malnutrition is a common problem in critically ill dogs and is associated with increased morbidity and mortality in human medicine. Enteral nutrition (EN) delivery methods have been evaluated in humans to determine which is most effective in achieving caloric goals. Objectives: To compare continuous infusion and intermittent bolus feeding of EN in dogs admitted to a critical care unit. Animals: Fifty‐four dogs admitted to the critical care unit and requiring nutritional support with a nasoenteric feeding tube. Methods: Prospective randomized clinical trial. Dogs were randomized to receive either continuous infusion (Group C) or intermittent bolus feeding (Group I) of liquid EN. The percentage of prescribed nutrition delivered (PPND) was calculated every 24 hours. Frequencies of gastrointestinal (GI), mechanical, and technical complications were recorded and gastric residual volumes (GRVs) were measured. Results: PPND was significantly lower in Group C (98.4%) than Group I (100%). There was no significant difference in GI or mechanical complications, although Group C had a significantly higher rate of technical complications. GRVs did not differ significantly between Group C (3.1 mL/kg) and Group I (6.3 mL/kg) and were not correlated with the incidence of vomiting or regurgitation. Conclusions and Clinical Importance: There was a statistically significant difference in the PPND between continuously and intermittently fed dogs, but this difference is unlikely to be clinically relevant. Critically ill dogs can be successfully supported with either continuous infusion or intermittent bolus feeding of EN with few complications. Increased GRVs may not warrant termination of enteral feeding.

Comparison of complication rates in dogs with nasoesophageal versus nasogastric feeding tubes

“…In this small retrospective study, a difference between NE and NG feeding tubes was not detected for any of the complications recorded (ie, vomiting/ regurgitation, diarrhea, epistaxis, clogged tube, early displacement/removal, aspiration pneumonia, hyperglycemia). Rates of these complications (5/46 [11%] for vomiting/regurgitation and 4/46 [9%] for diarrhea) are either similar to or lower than those previously reported (10–30% for vomiting/regurgitation and 10–26% for diarrhea) . Vomiting/regurgitation and diarrhea were considered to be complications only if they had not been present prior to initiating tube feedings, and it was not possible to retrospectively determine if these clinical signs were exacerbated by EN.…”

“…Rates of these complications (5/46 [11%] for vomiting/regurgitation and 4/46 [9%] for diarrhea) are either similar to or lower than those previously reported (10-30% for vomiting/regurgitation and 10-26% for diarrhea). 3,[7][8][9][10][11] Vomiting/regurgitation and diarrhea were considered to be complications only if they had not been present prior to initiating tube feedings, and it was not possible to retrospectively determine if these clinical signs were exacerbated by EN. Therefore, the current study may have underestimated potential adverse effects on gastrointestinal signs.…”

“…Other potential complications include dacrocystitis, rhinitis, aspiration pneumonia, clogged tubes, diarrhea (reported in 10-26% cases), vomiting/regurgitation (reported in 10-30%), and early removal/displacement (reported in 9-50%). [7][8][9][10][11] There are anecdotal reports of reasons for preferred location of the distal tip of the tube in either the distal esophagus (NE tube) or the stomach (NG tube). 12,13 For example, it has been reported that NG tubes increase the risk for complications such as regurgitation, gastroesophageal reflux, and reflux esophagitis/strictures because the tube crosses the lower esophageal sphincter.…”

“…In one of the earliest studies, published in 1986, difficulty in placement and subsequent mild epistaxis was noted in 2/11 dogs, but in a study using an improved placement technique, epistaxis did not occur in any of the 51 animals. Other potential complications include dacrocystitis, rhinitis, aspiration pneumonia, clogged tubes, diarrhea (reported in 10–26% cases), vomiting/regurgitation (reported in 10–30%), and early removal/displacement (reported in 9–50%) . There are anecdotal reports of reasons for preferred location of the distal tip of the tube in either the distal esophagus (NE tube) or the stomach (NG tube) .…”

Esophagojejunostomy Feeding Tube Placement in 5 Dogs with Pancreatitis and Anorexia

“…However, enteral feeding when fed as a CRI or with intermittent boluses has been found to be well tolerated in dogs [3, 9, 10]. In the present study, intermittent bolus feeding also allowed for patients to be cared for outside of the hospital setting which resulted in shorter hospitalization times and reduced costs to the owners.…”