Abstract
The appropriate strategy for enteral feeding remains a matter of debate. We hypothesized that continuous enteral feeding would result in higher rates of achieving target nutrition during the first 7 days compared with intermittent enteral feeding. We conducted an unblinded, single-center, parallel-group, randomized controlled trial involving adult patients admitted to the medical intensive care unit who required mechanical ventilation to determine the efficacy and safety of continuous enteral feeding for critically ill patients compared with intermittent enteral feeding. The primary endpoint was the achievement of ≥80% of the target nutrition requirement during the first 7 days after starting enteral feeding. A total of 99 patients were included in the modified intention-to-treat analysis (intermittent enteral feeding group, n = 49; continuous enteral feeding group, n = 50). The intermittent enteral feeding group and continuous enteral feeding group received 227 days and 226 days of enteral feeding, respectively. The achievement of ≥80% of the target nutrition requirement occurred significantly more frequently in the continuous enteral feeding group than in the intermittent enteral feeding group (65.0% versus 52.4%, respectively; relative risk, 1.24; 95% confidence interval, 1.06–1.45; p = 0.008). For patients undergoing mechanical ventilation, continuous enteral feeding significantly improved the achievement of target nutrition requirements.
Highlights
Major clinical practice guidelines emphasize the importance of early enteral nutrition (EN) for critically ill patients
The mean age was 66.9 ± 11.5 years, 66.7% of the patients were men, the mean body mass index was 22.6 ± 3.9 kg/m2, 36.4% had cardiovascular disease, 30.3% had diabetes mellitus, 44.4% were diagnosed with malignancy, the mean Sequential Organ Failure Assessment (SOFA) score was 8.8 ± 4.3, and the mean Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score was 28.2 ± 8.6
We identified 28 patients (28.3%) with hypophosphatemia; there was no difference in hypophosphatemia incidence between the intermittent enteral feeding group and continuous enteral feeding group (15 patients (30.6%) versus 13 patients (26.0%), respectively; p = 0.774)
Summary
Major clinical practice guidelines emphasize the importance of early enteral nutrition (EN) for critically ill patients. Undernutrition has been associated with an increased risk of complications such as nosocomial infections and mortality [3,4,5]. These deficits were highest during the first week of admission and were not fully balanced during the remaining intensive care unit (ICU) stay [6]. An hourly rate of EN was administered using a feeding pump during continuous feeding. Despite the lack of supporting evidence to make strong recommendations for its use, continuous feeding has been favored over intermittent feeding [8,14,15]
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