Prospective Randomized Control Trial of Intermittent Versus Continuous Gastric Feeds for Critically Ill Trauma Patients

Abstract

Background: This study compared an intermittent feeding regimen (one‐sixth of daily needs infused every 4 hours) with a continuous (drip) feeding regimen for critically ill trauma patients. There were two outcome variables: time to reach goal volume and the days on 100% of caloric needs via an enteral route in the first 10 days of the intensive care unit stay. Adverse events were also tallied. Methods: A prospective randomized trial was conducted in the trauma intensive care unit in a university Level I trauma center. A total of 164 trauma patients, 18 years of age and older were admitted to the trauma intensive care unit with a noninjured gastrointestinal tract and required more than 48 hours of mechanical ventilation. Patients were randomized to receive enteral nutrition via an intermittent feeding regimen versus a continuous feeding regimen. A single nutritionist calculated caloric and protein goals. A strict protocol was followed where hourly enteral intake, interruptions and their causes, diarrhea, and pneumonia were recorded, as well as standard guidelines for intolerance. Results: A total of 164 patients were randomized and 139 reached their calculated nutritional goal within 7 days. There were no statistical differences in complications of tube feeding. The patients intermittently fed reached the goal faster and by day 7 had a higher probability of being at goal than did the patients fed continuously (χ= 6.01, p= 0.01). Intermittent patients maintained 100% of goal for 4 of 10 days per patient (95% CI = 3.5–4.4) as compared with the drip arm goal for only 3 of 10 days per patient (95% CI = 2.7–3.6). Conclusions: Patients from both the intermittent and continuous feeding regimens reached the goal during the study period of 7 days but the intermittent regimen patients reached goal enteral calories earlier. The intermittent gastric regimen is logistically simple and has equivalent outcomes to a standard dripfeeding regimen.

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

“…In the current study, the method of liquid nutrition delivered via NE tube in critically ill dogs did impact PPND. Randomized controlled trials in human patients have compared continuous EN with intermittent bolus feeding with conflicting results 9,11–15 . Results of 2 recent studies suggest that patients fed intermittently reached goal feeds faster than continuously fed patients, and had a higher probability of being at goal feeds by day 7 of EN support 9,15 .…”

“…Randomized controlled trials in human patients have compared continuous EN with intermittent bolus feeding with conflicting results 9,11–15 . Results of 2 recent studies suggest that patients fed intermittently reached goal feeds faster than continuously fed patients, and had a higher probability of being at goal feeds by day 7 of EN support 9,15 . Intermittently fed patients also maintained 100% of the goal for 4 of 10 days as compared with the continuously fed patients who maintained goal for only 3 of 10 days 9 .…”

“…Critically ill patients with impaired gastrointestinal (GI) motility may tolerate continuous infusion of nutrition better, whereas intermittent bolus feeding represents a more physiologic method of providing calories. Randomized, controlled trials in human patients have failed to determine which delivery method is superior in providing prescribed calories with minimal complications 9,11–15 . Few studies have examined EN delivery systems in critically ill small animals.…”

THE TREND OF ENTERAL FEEDING AMONG CRITICALLY- ILL PATIENTS IN ADULT ICUs IN MALAYSIA

“…Previous studies in the literature have provided support on the use of intermittent feeding on the grounds that patients reach adequacy of calorie intake earlier that continuous feeding [22,23]. In contrast, continuous feeding is mostly used in acute phases; therefore there may be a delay in receiving adequate calories.…”

Reducing interruptions to continuous enteral nutrition in the intensive care unit: a comparative study

“…, MacLeod et al . , Hacker & Harvey‐Banchik ). Continuous EN using an EN delivery system (Bankhead et al .…”