Continuous Versus Intermittent Research Articles

Linezolid Pharmacokinetics in Critically Ill Patients: Continuous Versus Intermittent Infusion.

Linezolid has been found to have considerable interindividual variability, especially in critically ill patients, which can lead to suboptimal plasma concentration. To overcome this shortcoming, several solutions have been proposed. These include using loading dose, higher maintenance doses, and dose stratification according to the patient's particularities, therapeutic drug monitoring, and drug administration via continuous infusion (CI) instead of intermittent infusion (II). In the present study, we aim to compare the pharmacokinetic (PK) parameters of linezolid after administration as II versus CI to critically ill patients. In a prospective study conducted in an intensive care unit, we compared the same two daily doses of linezolid administered via II versus CI. The serum concentration was measured, and pharmacokinetic parameters were calculated. The pharmacokinetic/pharmacodynamic (PK/PD) indices for efficacy chosen were area under the concentration-time curve at steady state divided by the minimum inhibitory concentration over 80 (AUC24-48/MIC > 80). Greater serum concentration variability was observed in the II group than in the CI group. The %T > MIC > 80% was achieved for MICs of 1 and 2 µg/mL 100% of the time, whereas for the II group, this was 93% and 73%, respectively. AUC24-48/MIC > 80 was reached in 100% of cases in the CI group compared with 87% in the II group for a MIC of 1 µg/mL. The two infusion methods may be used comparably, but utilizing CI as an alternative to II may have potential benefits, including avoiding periods of suboptimal concentrations, which may enhance safety profiles and clinical outcomes. Considering the relatively few studies performed on linezolid to date, which are increasing in number, the results of the present study may be of interest.

Continuous Versus Intermittent Vancomycin Infusions for Coagulase-negative Staphylococcus Bacteremia in Neonates: A Propensity-matched Cohort Study.

Coagulase-negative staphylococci (CONS) are a major cause of late-onset neonatal sepsis, particularly in preterm infants, with high morbidity and mortality. While vancomycin is the first-line treatment for these infections, the optimal administration in neonates remains uncertain. We aim to compare the outcomes of neonates with CONS bacteremia treated with adjusted continuous infusion (CIV) versus standard intermittent infusion (IIV) of vancomycin. This retrospective study included 110 neonates, with 29 in the CIV group and 47 in the IIV group after propensity score matching. The primary outcome was treatment failure defined by the persistence of a positive blood culture for the same organism after at least 48 hours of vancomycin treatment. After matching, the CIV group exhibited significantly lower treatment failure rates [5/29 (17%) vs. 26/47 (44%); P = 0.014] and a higher rate of achieving therapeutic vancomycin levels after 24 hours [20/29 (69%) vs. 26/47 (44%); P = 0.002] compared to the IIV group. No significant differences were observed in terms of acute kidney failure between the 2 groups. Adjusted continuous vancomycin infusion in neonates with CONS bacteremia is associated with a lower treatment failure rate without an increase in renal toxicity compared to standard intermittent infusion. However, due to the observational design, larger prospective studies are needed to validate these results.

An Evaluative Comparison of Continuous Versus Intermittent Hydrocortisone Administration in the Therapeutic Approach to Septic Shock

An Evaluative Comparison of Continuous Versus Intermittent Hydrocortisone Administration in the Therapeutic Approach to Septic Shock

Comparative Evaluation of Haemodynamic Effects of Continuous Versus Intermittent Epidural Injections of Bupivacaine with Fentanyl for Major Gynaecological Surgeries

Background: Epidural anaesthesia can be administered as single shot, intermittently, continuously or as patient controlled injection. Our study compared the intraoperative haemodynamic effects of continuous versus intermittent epidural injections of bupivacaine with fentanyl for major gynaecological surgeries.

Continuous Versus Intermittent Nutrition in Pediatric Intensive Care Patients: Protocol for a Randomized Controlled Trial.

BackgroundIntermittent fasting is a time-restricted feeding strategy with proven health benefits, which is based on multiple metabolic and endocrine changes, in several patient populations and healthy participants. In the pediatric intensive care unit (PICU), artificial feeding is usually administered 24 hours a day, although solid evidence supporting this practice is lacking. This discards the potential benefits of fasting in this population. We hypothesize that intermittent nutrition with a focus on an overnight feeding interruption (intermittent fasting), as compared with 24-hour continuous nutrition, is a feasible and safe strategy, with potential benefits, for critically ill children.ObjectiveThe aim of the Continuous versus Intermittent Nutrition in Pediatric Intensive Care randomized controlled trial (RCT) is to investigate a strategy of intermittent nutrition with a focus on an overnight feeding interruption period versus 24-hour nutrition during the first 14 days in the PICU.MethodsThe Continuous versus Intermittent Nutrition in Pediatric Intensive Care study is an investigator-initiated RCT in a tertiary referral PICU. Critically ill children (term newborn to 18 years), expected to stay in the PICU for ≥48 hours, and dependent on artificial nutrition, are eligible for inclusion. This study will randomize critically ill children (n=140) to a continuous versus intermittent nutrition strategy. In both groups, similar daily caloric targets will be prescribed. In the continuous group (control), nutrition will be administered 24 hours a day, with a maximum interruption period of 2 hours. In the intermittent group (intervention), nutrition will be interrupted during an age-dependent overnight fasting period. The study intervention will last until admission day 14, initiation of oral intake, or discharge from the PICU, whichever comes first. The primary outcome is the difference in ketosis between the groups under the condition of noninferiority regarding caloric intake. Secondary outcomes are feeding intolerance; the proportion of severe and resistant hypoglycemic events and severe gastrointestinal complications; and additional observed effects on nutritional intake, circadian rhythm, and clinically relevant outcome measures of the intermittent feeding strategy compared with continuous nutrition.ResultsThe study was approved by the Dutch national ethical review board in February 2020. The first patient was enrolled on May 19, 2020. By May 2022, a total of 132 patients had been included in the study. Recruitment of the last patient is expected in Q3 2022.ConclusionsAlthough intermittent fasting has been proven to have many health benefits in both animal and human studies, the feasibility and safety of this strategy in a PICU setting must be investigated. This RCT will help physicians gain more insight into the feasibility, safety, and potential clinical effects of intermittent feeding with overnight fasting in critically ill children.Trial RegistrationNetherlands Trial Register NL7877; https://trialsearch.who.int/Trial2.aspx?TrialID=NL7877International Registered Report Identifier (IRRID)DERR1-10.2196/36229

Perceptual Adaptation to Continuous Versus Intermittent Exposure to Spatial Distortions.

PurposeTo examine perceptual adaptation when people wear spectacles that produce unequal retinal image magnification.MethodsTwo groups of 15 participants (10 male; mean age 25.6 ± 4.9 years) wore spectacles with a 3.8% horizontal magnifier over one eye. The continuous-wear group wore the spectacles for 5 hours straight. The intermittent-wear group wore them for five 1-hour intervals. To measure slant and shape distortions produced by the spectacles, participants adjusted visual stimuli until they appeared frontoparallel or equiangular, respectively. Adaptation was quantified as the difference in responses at the beginning and end of wearing the spectacles. Aftereffects were quantified as the difference before and after removing the spectacles. We hypothesized that intermittent wear may lead to visual cue reweighting, so we fit a cue combination model to the data and examined changes in weights given to perspective and binocular disparity slant cues.ResultsBoth groups experienced significant shape adaptation and aftereffects. The continuous-wear group underwent significant slant adaptation and the intermittent group did not, but there was no significant difference between groups, suggesting that the difference in adaptation was negligible. There was no evidence for cue reweighting in the intermittent wear group, but unexpectedly, the weight given to binocular disparity cues for slant increased significantly in the continuous-wear group.ConclusionsWe did not find strong evidence that adaptation to spatial distortions differed between the two groups. However, there may be differences in the cue weighting strategies employed when spectacles are worn intermittently or continuously.

Continuous Versus Intermittent Linezolid Infusion for Critically Ill Patients with Hospital-Acquired and Ventilator-Associated Pneumonia: Efficacy and Safety Challenges.

High variability of linezolid blood concentrations with partial subtherapeutic levels was observed in critically ill patients who received a standard intravenous dose of linezolid, contributing to drug resistance and toxicity. Continuous infusions of linezolid have been suggested as an alternative and provide good serum and alveolar levels without fluctuations in trough concentration. This study aimed to assess the effectiveness and safety of continuous linezolid infusion versus the standard regimen in critically ill patients. A prospective randomized controlled study was conducted on 179 patients with nosocomial pneumonia. Patients were randomized into two groups. The first group received IV linezolid 600 mg twice daily, while the second group received 600 mg IV as a loading dose, followed by a continuous infusion of 1200 mg/day (50 mg/h) for at least 8–10 days. The continuous infusion group showed a higher clinical cure rate than the intermittent infusion group (p = 0.046). Furthermore, efficacy was proven by greater improvement of P/F ratio (p = 0.030) on day 7 of treatment, a lower incidence of developing sepsis after beginning treatment (p = 0.009), and a shorter time to reach clinical cure (p < 0.001). Hematological parameters were also assessed during the treatment to evaluate the safety between the two groups. The incidence of thrombocytopenia was significantly lower in the continuous infusion group than in the intermittent infusion group. In addition, a stepwise logistic regression model revealed that the intermittent infusion of linezolid was significantly associated with thrombocytopenia (OR =4.128; 95% CI = 1.681–10.139; p =0.001). The current study is the first to assess the clinical aspects of continuous infusion of linezolid beyond pharmacokinetic studies. Continuous infusion of linezolid outperforms intermittent delivery in safety and improves clinical effectiveness in critically ill patients with Gram-positive nosocomial pneumonia.

Comparative Study of Continuous Versus Intermittent Subglottic Suction Drainage to Prevent Ventilator Associated Pneumonia in Intubated Patients

Introduction: Subglottic secretion drainage reduces the incidence of ventilator associated pneumonia (VAP). The efficacy of Continuous subglottic secretion drainage (CSSD) over Intermittent subglottic secretion drainage (ISSD) for prevention of VAP is unknown.&#x0D; Objectives: Compare the efficacy of CSSD and ISSD in terms of incidence of VAP, mortality, duration of mechanical ventilation, length of ICU stay and incidence of reintubation.&#x0D; Methodology: This was a prospective comparative study conducted at Birat Medical College and Teaching Hospital. A total number of 80 intubated patients for at least 48 hours duration were included. Continuous and intermittent endotracheal suctioning techniques were compared for prevention of VAP and secondary outcomes in terms of length of mechanical ventilation, length of ICU stay, multiorgan failure, reintubation and mortality rate.&#x0D; Results: The incidence of VAP was 15% and 22.5 % in CSSD group while it was 17.5% and 27.5% in ISSD group in first 48 hours and 96 hours of mechanical ventilation respectively.The length of mechanical ventilation was significantly less in continuous group (4.78 ± 2.50 days) than in intermittent group (7.18 ± 2.09 days) with p value of 0.023. The patients with CSSD had significantly shorter ICU stay (5.49 ± 3.16 days) as compared to the patients with ISSD (8.46 ± 2.06 days). The incidence of reintubation was significantly higher in intermittent group patients (p value 0.024). Patients in both the group had comparable incidence of multiorgan failure, spontaneous breathing trial and mortality rate.&#x0D; Conclusion: The incidences of VAP and mortality were comparable in CSSD and ISSD. However CSSD significantly decreased the duration of mechanical ventilation, length of ICU stay and incidence of reintubation..

Acute Physiological Effects of Continuous Versus Intermittent Walking During Golf in Individuals With Knee Osteoarthritis: A Pilot Study.

The aim of the study was to compare the acute effects of walking the golf course versus using a golf cart during a round of golf on biological markers of joint disease, joint pain, and cardiovascular parameters in individuals with knee osteoarthritis. Participants with knee OA (n = 10) older than 50 yrs were recruited for this crossover designed study in which they completed two 18-hole rounds of golf: (1) walking the course and (2) using a golf cart. Five control participants (n = 5) performed the walking condition only. Step count, heart rate, rating of perceived exertion and pain using the Numeric Pain Rating Scale were measured during the round. Serum was collected at baseline, 9th hole (halfway), and 18th hole (completion) and tested for biomarkers associated with tissue turnover (cartilage oligomeric matrix protein), inflammation (tumor necrosis factor α, interleukin 1β, interleukin 6), and degradative enzyme production (matrix metalloproteinase 3, matrix metalloproteinase 13). In knee OA participants, walking the course was associated with significantly higher step count and duration of moderate/vigorous physical activity (72.2% vs. 32.6% of the round) but did lead to a significant increase in knee joint pain (P < 0.05). Both conditions caused cartilage oligomeric matrix protein and matrix metalloproteinase 13 concentration increases from baseline to completion (P < 0.05), but inflammatory markers (tumor necrosis factor α, interleukin 6, and interleukin 1β, P < 0.05) only increased when walking the course. Biomarker concentrations did not increase in control participants. Walking the course optimizes the duration of moderate/vigorous activity during a round of golf, but the golf cart is a beneficial option in those with exacerbated joint pain and inflammation that would otherwise limit participation.

Continuous Versus Intermittent Running: Acute Performance Decrement and Training Load.

To examine the effect of continuous (CON) and intermittent (INT) running training sessions of different durations and intensities on subsequent performance and calculated training load (TL). Runners (N = 11) performed a 1500-m time trial as a baseline and after completing 4 different running training sessions. The training sessions were performed in a randomized order and were either maximal for 10minutes (10CON and 10INT) or submaximal for 25minutes (25CON and 25INT). An acute performance decrement (APD) was calculated as the percentage change in 1500-m time-trial speed measured after training compared with baseline. The pattern of APD response was compared with that for several TL metrics (bTRIMP, eTRIMP, iTRIMP, running training stress score, and session rating of perceived exertion) for the respective training sessions. Average speed (P < .001, ηp2=.924) was different for each of the initial training sessions, which all resulted in a significant APD. This APD was similar when compared across the sessions except for a greater APD found after 10INT versus 25CON (P = .02). In contrast, most TL metrics were different and showed the opposite response to APD, being higher for CON versus INT and lower for 10- versus 25-minute sessions (P < .001, ηp2>.563). An APD was observed consistently after running training sessions, but it was not consistent with most of the calculated TL metrics. The lack of agreement found between APD and TL suggests that current methods for quantifying TL are flawed when used to compare CON and INT running training sessions of different durations and intensities.

Practical Considerations and Successful Implementation of Vital Signs Monitoring. Comment on “Continuous Versus Intermittent Vital Signs Monitoring Using a Wearable, Wireless Patch in Patients Admitted to Surgical Wards: Pilot Cluster Randomized Controlled Trial”

Practical Considerations and Successful Implementation of Vital Signs Monitoring. Comment on “Continuous Versus Intermittent Vital Signs Monitoring Using a Wearable, Wireless Patch in Patients Admitted to Surgical Wards: Pilot Cluster Randomized Controlled Trial”

Continuous Versus Intermittent Infusion of Vancomycin and the Risk of Acute Kidney Injury in Critically Ill Adults: A Systematic Review and Meta-Analysis.

Critically ill patients routinely receive vancomycin as empiric antibiotic therapy. A continuous infusion administration strategy may be superior to intermittent infusion by minimizing peak concentrations and variability thereby optimizing safety. We performed a systematic review and meta-analysis to investigate the impact of vancomycin infusion strategy on acute kidney injury in critically ill adults. A systematic search of MEDLINE, CINAHL, Web of Science, International Pharmaceutical Abstracts, and Google Scholar was undertaken. We included randomized controlled trials and observational studies evaluating acute kidney injury in critically ill adults comparing vancomycin administered by intermittent and continuous infusion. Secondary outcomes included mortality and pharmacokinetic target attainment. Eleven studies were identified for analysis with baseline demographics, endpoints, protocol definitions, and outcomes extracted. When compared with intermittent infusion, continuous infusion was associated with a reduction in acute kidney injury in critically ill adults (odds ratio, 0.47; 95% CI, 0.34-0.65) and a 2.6 greater odds of pharmacokinetic target attainment (odds ratio, 2.63; 95% CI, 1.52-4.57). No difference in mortality was observed (odds ratio, 1.04; 95% CI, 0.80-1.35). When administered via a continuous infusion, vancomycin is associated with a 53% reduction in the odds of acute kidney injury and a 2.6-fold higher odds of pharmacokinetic target attainment when compared with intermittent infusion without influencing overall mortality.

Continuous Versus Intermittent Oxytocin Infusion for Induction of Labor

Continuous Versus Intermittent Oxytocin Infusion for Induction of Labor

Continuous Versus Intermittent Vital Signs Monitoring Using a Wearable, Wireless Patch in Patients Admitted to Surgical Wards: Pilot Cluster Randomized Controlled Trial.

BackgroundVital signs monitoring is a universal tool for the detection of postoperative complications; however, unwell patients can be missed between traditional observation rounds. New remote monitoring technologies promise to convey the benefits of continuous monitoring to patients in general wards.ObjectiveThe aim of this pilot study was to evaluate whether continuous remote vital signs monitoring is a practical and acceptable way of monitoring surgical patients and to optimize the delivery of a definitive trial.MethodsWe performed a prospective, cluster-randomized, parallel-group, unblinded, controlled pilot study. Patients admitted to 2 surgical wards at a large tertiary hospital received either continuous and intermittent vital signs monitoring or intermittent monitoring alone using an early warning score system. Continuous monitoring was provided by a wireless patch, worn on the patient’s chest, with data transmitted wirelessly every 2 minutes to a central monitoring station or a mobile device carried by the patient’s nurse. The primary outcome measure was time to administration of antibiotics in sepsis. The secondary outcome measures included the length of hospital stay, 30-day readmission rate, mortality, and patient acceptability.ResultsOverall, 226 patients were randomized between January and June 2017. Of 226 patients, 140 were randomized to continuous remote monitoring and 86 to intermittent monitoring alone. On average, patients receiving continuous monitoring were administered antibiotics faster after evidence of sepsis (626 minutes, n=22, 95% CI 431.7-820.3 minutes vs 1012.8 minutes, n=12, 95% CI 425.0-1600.6 minutes), had a shorter average length of hospital stay (13.3 days, 95% CI 11.3-15.3 days vs 14.6 days, 95% CI 11.5-17.7 days), and were less likely to require readmission within 30 days of discharge (11.4%, 95% CI 6.16-16.7 vs 20.9%, 95% CI 12.3-29.5). Wide CIs suggest these differences are not statistically significant. Patients found the monitoring device to be acceptable in terms of comfort and perceived an enhanced sense of safety, despite 24% discontinuing the intervention early.ConclusionsRemote continuous vital signs monitoring on surgical wards is practical and acceptable to patients. Large, well-controlled studies in high-risk populations are required to determine whether the observed trends translate into a significant benefit for continuous over intermittent monitoring.Trial RegistrationInternational Standard Randomised Controlled Trial Number ISRCTN60999823; http://www.isrctn.com /ISRCTN60999823 (Archived by WebCite at http://www.webcitation.org/73ikP6OQz)

Comparison of Continuous Versus Intermittent Bolus Feeding in Preterm Infants ≤ 32 Weeks and ≤1250 G

Comparison of Continuous Versus Intermittent Bolus Feeding in Preterm Infants ≤ 32 Weeks and ≤1250 G

Comparison of Continuous Versus Intermittent Administration of Triptorelin on the Final Height of Girls with Idiopathic Precocious Puberty

Background: It has long been reported that gonadotropin releasing hormone (GnRH) analogs can improve final height of patients with idiopathic precocious puberty (IPP). This study aimed at comparing 2 different doses of GnRH agonist, triptorelin, on the adult height of girls with IPP. Methods: From July 2013, sixteen girls with IPP were randomly divided to 2 groups. The first Group received 1 intramuscular injection of triptorelin 0.3 mg/kg of body weight on a monthly basis, and the second group received this at months 1 to 6, 10 to 15, and 19 to 24. They did not receive triptorelin at months 7 to 9 and 16 to 18. Results: Patients in Group 1 received a total of 7.2 mg/kg of triptorelin during a 2-year follow up while the Group 2 received 5.4 mg/kg triptorelin or about 39.6 mg less than the other group during the same period of follow up. No side effects were noted in Group 2 receiving lower dose of triptorelin, yet, 2 cases with gray hair and 1 case with mild rash were reported in the group receiving the higher dose. No statistically significant difference was found between the 2 groups regarding height after 2 years. Conclusions: Treatment of IPP can be performed with triptorelin doses of less than 0.3 mg/kg per month, with the same height increment and lower side effects.

Randomized Comparison of Continuous Versus Intermittent Heparin Infusion During Catheter Ablation of AtrialFibrillation.

This study tested the hypothesis that continuous heparin infusions would be favorable for maintaining heparin concentrations during radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Heparin infusions are essential for RFCA of AF. There is a paucity of data on the details for the optimal heparin infusion during RFCA of AF. A total of 333 patients undergoing AF ablation were consecutively enrolled and randomized to intermittent or continuous heparin infusion. A heparin bolus of 100 U/kg was injected just prior to transseptal puncture. The heparin concentration necessary to maintain an optimal activated clotting time (ACT) (300 to 400 s) was determined andchecked every 30 min during the procedure. The primary endpoint of the study was the frequency of the maintenance ofan optimal intraprocedural ACT. The frequency of an optimal ACT in the continuous group was significantly higher than that in the intermittent group (64.0% vs. 57.6%, respectively, p< 0.01), whereas the total heparin level was significantly lower in the continuous group (13,162 ± 4,634 U vs. 15,837 ± 5,243 U, respectively, p< 0.01). The standard deviation of the ACT was significantly smaller in the continuous group than in the intermittent group (49 ± 30 vs. 33 ± 18, respectively, p<0.01). Ninety-six patients had new oral anticoagulants (NOACs) before the procedure, and an optimal ACT at the first ACT check was less frequent than in patients taking warfarin (12.5% vs. 59.1%, respectively, p< 0.01). There were no significant differences in periprocedural bleeding or thromboembolic complications between the groups. During AF ablation, a continuous heparin infusion was superior to an intermittent heparin infusion for maintaining an optimal ACT range. (Randomized Comparison of Continuous and Intermittent Heparin Infusion During Catheter Ablation of Atrial Fibrillation [COHERE]; NCT01935557).

The Efficacy of Continuous Versus Intermittent Celecoxib Treatment in Osteoarthritis Patients with Body Mass Index ≥30 and &lt;30 kg/m2

Objective:Characterize the effect of body mass index (BMI) on the efficacy of continuous daily celecoxib treatment compared with intermittent celecoxib treatment.Methods:Prespecified exploratory analysis of a 24-week, double-blind, parallel-group, randomized, multicenter international study. 858 patients with knee or hip osteoarthritis (OA) were randomized to receive celecoxib 200 mg daily either as continuous or intermittent treatment. Efficacy was measured by Western Ontario and McMaster Universities Arthritis Index (WOMAC) total and subscale scores and the number of flare events.Results:Least squares mean increases (worsening) in WOMAC total scores were significantly less in the continuous treatment group than in the intermittent treatment group in patients with a BMI <30 kg/m2 (1.33 vs 4.85; p=0.016) and in patients with a BMI ≥30 kg/m2 (1.84 vs 5.12; p=0.019). There was a greater worsening in patients with a BMI ≥30 kg/m2 than in those with a BMI <30 kg/m2 in both the continuous and intermittent groups. Fewer flares were reported in the continuous treatment group than in the intermittent group in patients with a BMI <30 kg/m2 (0.55 vs 0.88; p<0.0001) and ≥30 kg/m2 (0.54 vs 0.97; p<0.0001). There were no differences in adverse events in the two BMI groups.Conclusions:Continuous celecoxib treatment was significantly more efficacious than intermittent use in patients with a BMI <30 kg/m2 compared with obese patients (≥30 kg/m2) as assessed by WOMAC total scores and the number of flares. These data suggest that including weight loss as part of a treatment regimen for obese OA patients could be important.

Near‐Infrared Spectroscopy Measurements of Splanchnic Tissue Oxygenation During Continuous Versus Intermittent Feeding Method in Preterm Infants

The aim of the present study was to compare the effects of continuous and intermittent bolus milk feeding on splanchnic regional oxygenation (rSO₂S) in small-for-gestational age (SGA) and appropriate-for-gestational age (AGA) preterm infants. Infants with gestational age <32 weeks were prospectively studied by near-infrared spectroscopy. Each infant was given a milk bolus in ~10 minutes (intermittent feeding) followed after 3 hours by a 3-hour continuous feeding. rO₂S and splanchnic fractional oxygen extraction ratio (FOES [S = splanchnic]) were recorded 30 minutes before (T₀) and 30 minutes after the beginning of bolus feeding (T₁), 30 minutes before (T₂), at the end (T₃), and 30 minutes after the continuous feeding period (T₄). rSO2S increased at T₁ in both AGA and SGA groups, whereas FOES did not vary during the study period. Moreover, we found that rSO2S was higher and FOES was lower at T₁ and T₃ in the AGA than in the SGA group. Bolus milk feeding increases splanchnic oxygenation in both AGA and SGA infants, whereas continuous feeding does not. Splanchnic oxygenation is higher in AGA than in SGA infants both during bolus and continuous feeding. Continuous enteral feeding could help to limit the risk of hypoxic-ischemic gut damage in preterm infants in critical condition, especially in AGA infants.

Treatment of Osteoarthritis with Continuous Versus Intermittent Celecoxib

To determine whether "continuous" celecoxib is more efficacious than "intermittent" use in preventing osteoarthritis (OA) flares of the knee and/or hip. A double-blind, randomized, multicenter international study comparing efficacy and safety of continuous (daily) versus intermittent (as required during predefined OA flare) celecoxib 200 mg/day in 858 subjects, aged 18-80 years. The study consisted of 3 periods: (I) screening/washout visit; (II) open-label run-in with celecoxib; and (III) 22-week blinded treatment. Only subjects whose OA flares resolved in Period 2 (without subsequent flare) were randomized. The primary endpoint, number of flares per time of exposure during Period III (number of flares per month), was compared using analysis of variance with treatment as the independent variable. Acetaminophen was available as rescue medication. Of 875 subjects randomized to treatment, 858 subjects received treatment. At randomization > 70% were female; mean age 58.6 years; mean disease duration 6.5 years; total Western Ontario and McMaster Universities Osteoarthritis Index mean score 25.8; ~45% had hypertension; and ~20% were using aspirin (for cardiovascular prophylaxis). Subjects receiving continuous treatment reported 42% fewer OA flares/month than intermittent users (p < 0.0001) or 2.0 fewer OA flares over 22 weeks. Statistical and clinically meaningful benefits in secondary outcomes were also evident with continuous treatment. There were no differences in adverse events (AE) or new-onset/aggravated hypertension. Continuous treatment with celecoxib 200 mg/day was significantly more efficacious than intermittent use in preventing OA flares of the hip and knee, without an increase in overall AE, including gastrointestinal disorders and hypertension, during 22 weeks of treatment. ClinicalTrials.gov identifier NCT00139776.