Continuous versus Intermittent Enteral Tube Feeding for Critically Ill Patients: A Prospective, Randomized Controlled Trial

Lee, Hong Yeul; Lee, Jung‐Kyu; Kim, Hye-Jin; Ju, Dal Lae; Lee, Sang-Min; Lee, Jinwoo

doi:10.3390/nu14030664

Cited by 15 publications

(25 citation statements)

References 24 publications

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“…Interestingly, a number of studies have also evaluated the continuous versus the bolus feeding in adult patients with opposing results [ 27 ]. A recently published RCT in critically ill patients found that patients receiving continuous EN had higher achievement rates of the goal nutritional requirement than the intermittent group [ 28 ]. However, there are studies reporting the opposite effect, making the results inconsistent for the adult critically ill population [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Continuous versus Intermittent Enteral Feeding in Critically Ill Children: A Systematic Review

et al. 2023

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Administration of enteral nutrition (EN) in critically ill pediatric patients admitted to the pediatric intensive care unit (PICU) constitutes a major challenge due to the increased risk of complications, as well as the lack of well-trained healthcare professionals. EN is usually delivered via cyclic, continuous, or intermittent feeding; however, a number of potential barriers have been reported in the literature regarding different feeding regimens. The purpose of this review was to assess the effectiveness of continuous and intermittent bolus feeding on critically ill children. A systematic search was conducted in PubMed, Scopus Cochrane Central Register of Controlled Trials (CENTRAL) and a clinical trial registry up to September 2022, including randomized controlled trials (RCTs) published in the English language. Four studies met the inclusion criteria with a total population of 288 patients admitted to the PICU. Three studies were rated with a high risk of bias and one with some concerns. There was high heterogeneity between the studies in regard to the reporting of outcomes. Three studies measured the total time needed to reach prescribed caloric intake with conflicting results, while two studies evaluated the length of stay (LOS) in PICU with no difference between the two arms. One study assessed the time weaning from mechanical ventilation, favoring the bolus group. No data were provided for gastric residual volume (GRV), anthropometric measurements, and biochemical markers. Additional randomized trials with better methodology are needed to assess the efficacy of the two enteral feeding regimens in critically ill PICU patients.

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Section: Discussionmentioning

confidence: 99%

Continuous versus Intermittent Enteral Feeding in Critically Ill Children: A Systematic Review

et al. 2023

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“…46 Thus, as emphasized by the guidelines, critically ill patients should have their gastric tubes removed early on, with enteral nutrition being administered promptly. 47 In case the gastric tube is not expected to be removed in the short term, other feeding routes need to be considered, such as percutaneous endoscopic gastrostomy and intermittent oro-esophageal tube feeding. 48 The present study further highlighted the importance of external validation, because we found that the discriminative ability of models was significantly lower in the validation phase than in the development phase.…”

Section: Discussionmentioning

confidence: 99%

Prediction Models for Dysphagia in Intensive Care Unit after Mechanical Ventilation: A Systematic Review and Meta‐analysis

Chen

Wang

et al. 2023

The Laryngoscope

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ObjectiveDysphagia is a common condition that can independently lead to death in patients in the intensive care unit (ICU), particularly those who require mechanical ventilation. Despite extensive research on the predictors of dysphagia development, consistency across these studies is lacking. Therefore, this study aimed to identify predictors and summarize existing prediction models for dysphagia in ICU patients undergoing invasive mechanical ventilation.MethodsWe searched five databases: PubMed, EMBASE, Web of Science, Cochrane Library, and the China National Knowledge Infrastructure. Studies that developed a post‐extubation dysphagia risk prediction model in ICU were included. A meta‐analysis of individual predictor variables was performed with mixed‐effects models. The risk of bias was assessed using the prediction model risk of bias assessment tool (PROBAST).ResultsAfter screening 1,923 references, we ultimately included nine studies in our analysis. The most commonly identified risk predictors included in the final risk prediction model were the length of indwelling endotracheal tube ≥72 h, Acute Physiology and Chronic Health Evaluation (APACHE) II score ≥15, age ≥65 years, and duration of gastric tube ≥72 h. However, PROBAST analysis revealed a high risk of bias in the performance of these prediction models, mainly because of the lack of external validation, inadequate pre‐screening of variables, and improper treatment of continuous and categorical predictors.ConclusionsThese models are particularly susceptible to bias because of numerous limitations in their development and inadequate external validation. Future research should focus on externally validating the existing model in ICU patients with varying characteristics. Moreover, assessing the acceptance and effectiveness of the model in clinical practice is needed.Level of EvidenceN/A Laryngoscope, 2023

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“…International guidelines [ 19 ] recommend the use of continuous feeding rather than intermittent boluses due to the lower incidence of side effects such as diarrhea; however, despite a strong consensus the grade of the recommendation is low, mainly because of the limited sample size and heterogeneity of the populations included, and the lack of proven benefits in other outcome measures. Indeed, the debate about the best strategy to deliver enteral feeding has grown in the last years, based on the concept that an intermittent pattern could better mimic the normal daily life feeding pattern [ 63 ], and on reports that continuous enteral feeding might improve the achievement of target nutrition requirements as compared to an intermittent pattern [ 64 ]. A recent systematic review which included 19 studies that compared the two approaches found both results in favor of a continuous pattern (such as lower gastric residuals and less need for prokinetics), and in favor of an intermittent one (i.e., better digestive tract colonization, lower constipation and less evidence of tracheal aspiration of gastric contents), and confirmed that the current level of evidence is not sufficient to provide clear indications on which approach should be preferred [ 65 ].…”

Section: Discussionmentioning

confidence: 99%

Nutrition support for critically ill patients during the COVID-19 pandemic: the Italian SIAARTI survey

Tetamo

Fittipaldi

Buono

et al. 2022

J Anesth Analg Crit Care

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Background Critically ill, COVID-19 patients are characterized by a hypermetabolic state and a reduced food intake and are at high risk of malnutrition and lean body mass loss. An appropriate metabolic-nutritional intervention aims to reduce complications and improve the clinical outcomes. We conducted a cross-sectional, multicenter, observational, nationwide online survey involving Italian Intensivists to assess the nutritional practices in critically ill patients with COVID-19. Results A group of experts in nutrition of the Italian Society of Anaesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) developed a 24-item questionnaire; the 9000 members of the Society were invited to participate through emails and social networks. Data was collected from June 1 to August 1, 2021. A total of 545 responses were collected: 56% in northern, 25% in central, and 20% in southern Italy. Artificial nutrition support is directly handled by intensivists in > 90 of the cases; the nutritional status is assessed as suggested by the guidelines in more than 70% of the cases, and a form of nutrition support is started within the first 48 h from ICU admission by > 90% of the respondents. Nutritional targets are reached in 4–7 days in > 75% of the cases, mainly by the enteral route. Indirect calorimetry, muscle ultrasound, and bioimpedance analysis are used by a limited part of the interviewees. Only about a half of the respondents reported the nutritional issues in the ICU discharge summary. Conclusions This survey among Italian Intensivists during the COVID-19 epidemic showed how the beginning, progression, and route of nutritional support adhere to international recommendations, while recommendations on the tools to set the target and monitor the efficacy of the metabolic support are less followed.

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Continuous versus Intermittent Enteral Tube Feeding for Critically Ill Patients: A Prospective, Randomized Controlled Trial

Cited by 15 publications

References 24 publications

Continuous versus Intermittent Enteral Feeding in Critically Ill Children: A Systematic Review

Continuous versus Intermittent Enteral Feeding in Critically Ill Children: A Systematic Review

Prediction Models for Dysphagia in Intensive Care Unit after Mechanical Ventilation: A Systematic Review and Meta‐analysis

Nutrition support for critically ill patients during the COVID-19 pandemic: the Italian SIAARTI survey

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