Comparison of sequential feeding and continuous feeding on the blood glucose of critically ill patients: a non-inferiority randomized controlled trial

Abstract

Background:Glucose control is an important aspect in managing critically ill patients. The goal of this study was to compare the effects of sequential feeding (SF) and continuous feeding (CF) on the blood glucose of critically ill patients.Methods:A non-inferiority randomized controlled trial was adopted in this study. A total of 62 patients who were fed enteral nutritional suspension through gastric tubes were enrolled. After achieving 80% of the nutrition target calories (25 kcal·kg−1·day−1) through CF, the patients were then randomly assigned into SF and CF groups. In the SF group, the feeding/fasting time was reasonably determined according to the circadian rhythm of the human body as laid out in traditional Chinese medicine theory. The total daily dosage of the enteral nutritional suspension was equally distributed among three time periods of 7 to 9 o’clock, 11 to 13 o’clock, and 17 to 19 o’clock. The enteral nutritional suspension in each time period was pumped at a uniform rate within 2 h by an enteral feeding pump. In the CF group, patients received CF at a constant velocity by an enteral feeding pump throughout the study. Blood glucose values at five points (6:00/11:00/15:00/21:00/1:00) were monitored and recorded for seven consecutive days after randomization. Enteral feeding intolerance was also recorded. Non-inferiority testing was adopted in this study, the chi-square test or Fisher test was used for qualitative data, and the Mann-Whitney U test was used for quantitative data to determine differences between groups. In particular, a repeated measure one-way analysis of variance was used to identify whether changes in glucose value variables across the time points were different between the two groups.Results:There were no significant demographic or physiological differences between the SF and CF groups (P > 0.050). The average glucose level in SF was not higher than that in CF (8.8 [7.3–10.3] vs. 10.7 [9.1–12.1] mmol/L, Z = −2.079, P for non-inferiority = 0.019). Hyperglycemia incidence of each patient was more common in the CF group than that in the SF group (38.4 [19.1–63.7]% vs. 11.8 [3.0–36.7]%, Z = −2.213, P = 0.027). Hypoglycemia was not found in either group. Moreover, there was no significant difference during the 7 days in the incidence of feeding intolerance (P > 0.050).Conclusions:In this non-inferiority study, the average blood glucose in SF was not inferior to that in CF. The feeding intolerance in SF was similar to that in CF. SF may be as safe as CF for critically ill patients.Trial RegistrationClinicalTrials.gov, NCT03439618; https://clinicaltrials.gov/ct2/show/record/NCT03439618

Circadian rhythm disruption in critically ill patients

“…158 In critically ill patients, intermittent bolus feeding during daytime has been shown to reduce hyperglycemia incidence and number of days with mechanical ventilation compared to continuous nutrition. 159 The effect of cyclic intermittent feeding is a potential approach to synchronize circadian rhythms in critically ill patients, which has not yet been investigated. In both animal and human studies, intermittent fasting has been shown to have many health benefits.…”

“…In healthy young men, compromised insulin sensitivity in the skeletal muscle was observed in an experimental setting of controlled circadian misalignment by night‐time food intake, light exposure, and shifted sleeping periods 158 . In critically ill patients, intermittent bolus feeding during daytime has been shown to reduce hyperglycemia incidence and number of days with mechanical ventilation compared to continuous nutrition 159 . The effect of cyclic intermittent feeding is a potential approach to synchronize circadian rhythms in critically ill patients, which has not yet been investigated.…”

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

“…Metode pemberian nutrisi enteral diantaranya; 1) continuous feeding; 2) cyclic feeding; 3) intermittent feeding; 4) sequential feeding dan 5) bolus feeding. Jika dilihat dari waktu pemberiannya maka continuous dan cyclic feeding merupakan jenis metode pemberian nutrisi yang secara terus-menerus selama 24 jam yang membedakan adalah terdapat jeda waktu istirahat beberapa jam pada metode cyclic (Ren et al, 2021;Mcnelly et al, 2020).…”

“…Hasil penelitian Mcnelly et al, (2020) metode intermittent digunakan 6 kali makan setiap 4 jam selama 24 jam diberikan melalui selang nasogastric menggunakan spuit selama 3-5 menit. Pada metode sequential feeding dalam penelitian Ren et al, (2021) pemberian nutrisi didistribusikan secara merata ketiga periode waktu dengan kecepatan seragam dalam waktu 2 jam yakni pukul 7-9, pukul 11-13 dan pukul 17-19 dari total dosis harian nutrisi enteral sesuai kebutuhan pasien. 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.…”

“…Hasil penelitian menunjukkan kadar glukosa rata-rata pada sequential feeding tidak lebih tinggi dari pada continuous feeding. Selain itu, insiden hiperglikemia lebih tinggi pada kelompok continuous feeding daripada kelompok sequential feeding (Ren et al, 2021) Jenis dan komposisi nutrisi yang diberikan pun memegang peranan penting di dalam kontrol glikemik, sehingga perlu perhitungan kebutuhan nutrisi dan kalori yang tepat untuk pasien kritis dengan berkolaborasi dengan ahli gizi dan dokter spesialis gizi. Dalam penelitian Murphy et al, (2013) semua pasien diberi makan formula standar 1 kkal/mL untuk memenuhi perkiraan kebutuhan nutrisi.…”