Safety and efficacy of continuous or intermittent enteral nutrition in patients in the intensive care unit: Systematic review of clinical evidence

Abstract

The best mode of delivering enteral nutrition (EN) in the intensive care unit (ICU) is still debated: several consensus guidelines (American Society for Parenteral and Enteral Nutrition [ASPEN] and the European Society for Parental and Enteral Nutrition [ESPEN]) suggest that EN in ICU should be preferably delivered continuously rather intermittently, but some authors highlight that the first is unphysiological. The aim of this systematic review (SR) is to summarize available clinical evidence related to safety and efficacy of continuous EN (C‐EN) or intermittent EN (I‐EN) in patients in the ICU, in relation to appropriated supply on nutrition status, gastrointestinal symptoms or tolerance, and risks on respiratory tract infections. A literature search of PubMed, EMBASE, and Google Scholar was performed comparing C‐EN vs I‐EN, and 4196 published studies were screened. Nineteen studies were selected for this SR reporting types of ICU, nutrition protocols, and study period. Effects of C‐EN vs I‐EN were presented according to the impact on nutrition status, digestive tract, and respiratory tract. The contrasting results confirmed that the optimal delivering mode of EN remains controversial. Future studies dedicated to identifying the benefits and limitations of C‐EN or I‐EN should be realized.

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

“…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 ].…”

Gut microbiome alterations in ICU patients with enteral nutrition-related diarrhea

“…Enteral nutrition (EN) is a form of oral or tube feeding that provides food and other nutrients to the gastrointestinal tract of people who cannot eat normally ( Wischmeyer, 2021 ). Early nutritional support treatment helps to correct electrolyte and various nutritional metabolic disorders in patients and also effectively improves the body’s resistance, shortens the patient’s stay in the ICU and reduces the mortality rate ( Singer et al, 2019 ; De Lazzaro et al, 2022 ). The 2009 Nutrition Day Global Hospital Survey reports that approximately 10% of hospitalized patients in Europe and Japan receive enteral nutrition, with one-third using it as part of their energy supplement and another two-thirds using it as their sole energy source ( Schneider, 2010 ).…”