Safety of intermittent versus continuous enteral nutrition in critically ill patients. Randomized clinical trial

Abstract

Introduction

Enteral nutrition (EN) is a common nutritional support in intensive care units (ICU). The administration method can be continuous (CEN)or intermittent (IEN), but there are controversies and a lack of evidence on which method is more effective in achieving good nutritional status while minimizing complications.

Objectives

To evaluate the safety (no increase in complications) NEI versus NEC during administration of EN with a gastric feeding tube (GFT) in ICU patients.

Methods

Randomized,open clinical trial.Registered in Clinical Trials. Population: Adults >18 years admitted to ICU,with GFT, indication of EN, signed consent. Exclusion: insulin-dependent diabetic. Intervention: Control (CEN): continuous administration via infusion pump; Experimental (IEN): the total amount divided into 4 doses, administered q6 h via infusion pump,for 1 h each dose. Outcome variables: complications (gastrointestinal,respiratory,metabolic), achievement of caloric goal (CG) Others: demographic data, nutritional status, severity (APACHE), EN type, mechanical ventilation (MV), duration of EN, causes of interruption. Statistical analysis: SPSS. Intention-to-treat analysis. Measures of central tendency and dispersión (standard deviation or interquartile range: IQR), absolute and relative frequencies. Bivariate analysis: Chi2, t-Student, and U-Mann–Whitney. Ethical aspects: CEIm approval.

Results

40 patients (18CEN/22IEN), 70% (28) men, age 62.65 DE:13.27 years (95% CI 58.40−66.90), BMI: 27.93 (IQR:4.6), APACHE II: 18.85 DE: 5.83 (95% CI 16.98−20.72), MV:11.5days (IQR:13).17.5% (7) diabetic. The CEN and IEN groups were homogeneous for all variables except APACHE (CEN 21.22 vs IEN 16.91; p = 0.018). CG was achieved by 82.5% (33) (88.9% CEN vs77.3% IEN, p = 0.33), time to achieve it (36 h CEN vs 34 h IEN; p = 0.28). Complications: vomiting:20% (8) patients (4 per group, p = 0.75). Diarrhea: (16.7%CEN vs 22.7% IEN, p = 0.63). Bronchial aspiration and GRV >500cc 1 case in IEN. Median interruptions (2.5 (IQR: 2) CEN vs 1 (IQR: 2) IEN; p = 0.005).

Discussion

The results are similar to other studies. CG was achieved in a high percentage, with no differences between groups. The use of INE shows feweer interruptions, which may lead to better compliance with caloric guidelines without increasing complications, maintaining physiological guidelines.

Conclusion

IEN in ICU patients shows no differences in terms of complications, compared to CEN, nor less effectiveness in achieving the CG. A larger sample is needed to identify the advantages and complications of each method.