[Nutrition and gastrointestinal intolerance]. Med Klin Intensivmed Notfmed. 2013;108:396-400. [PMID: 23740106 DOI: 10.1007/s00063-012-0203-1]

Effects of intermittent feeding versus continuous feeding on enteral nutrition tolerance in critically ill patients: A protocol for systematic review and meta-analysis

BACKGROUND

Nutritional support is an indispensable treatment for critically ill patients. Enteral nutrition intolerance is one of the obstacles to the smooth progress of enteral nutrition.Enteral nutrition can be divided into continuous feeding and intermittent feeding. However, the effectiveness and safety of the 2 ways of nutrition infusion are controversial clinically. Therefore, this meta-analysis further evaluated the effect of intermittent feeding versus continuous feeding on enteral nutrition tolerance in critically ill patients.

METHODS

Cochrane Library, PubMed, Web of Science, EMbase, China Biology Medicine disc (CBM), China Science and Technology Journal Database (VIP), China Journal full-text Database (CNKI), and Wanfang Database were searched for all randomized controlled trials (RCTs) on the effects of intermittent and continuous feeding on enteral nutrition tolerance in critically ill patients. The quality of literatures was strictly evaluated and the data were extracted by 2 investigators. Meta-analysis was carried out by applying RevMan 5.5 software.

RESULTS

The results of this meta-analysis are published in peer-reviewed journals.

CONCLUSIONS

This study provides reliable evidence-based support for the effects of intermittent and continuous feeding on enteral nutrition tolerance in critically ill patients.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/4BP5X.

[Gastrointestinal motility in critically ill patients]

Up to 80% of all critically ill patients develop gastrointestinal dysfunction, predominantly gastrointestinal motility disorder. In critically ill patients, gastrointestinal dysfunction or gastrointestinal failure is associated with increased morbidity and mortality. Correct diagnosis and early start of treatment are essential and can influence the outcome. Therapeutic options are normal potassium and magnesium levels, restrictive fluid balance, improved gastrointestinal microcirculation, individual sedoanalgetic concepts and early enteral nutrition. In addition, numerous target-oriented medical therapeutic options are available.

Gastrointestinal motility dysfunction in critically ill patients: Pathogenesis, clinical assessment, and treatment

Gastrointestinal motility dysfunction is a common clinical complication in ICU patients, which can lead to difficulty in enteral nutrition, vomiting, diarrhea, increased intra-abdominal pressure, ventilator associated pneumonia, intestinal flora displacement, and other adverse reactions. The clinical features of gastrointestinal dysfunction mainly include gastric emptying disturbance, intestinal dysfunction, and gastrointestinal motility disorders. The causes of gastrointestinal motility dysfunction in ICU patients are complex and the clinical evaluation of gastrointestinal dysfunction is difficult. These factors have led to the fact that gastrointestinal motility monitoring techniques have not been widely used in clinical practice. Timely detection and correction of gastrointestinal motility dysfunction in ICU patients can improve outcomes. This article reviews the etiology, clinical evaluation, and treatment of gastrointestinal motility dysfunction in ICU patients.

Comparison of Intermittent and Bolus Enteral Feeding Methods on Enteral Feeding Intolerance of Patients with Sepsis: A Triple-blind Controlled Trial in Intensive Care Units

BACKGROUND

Recent trials have shown controversial results on which enteral feeding methods has a lower risk of enteral feeding intolerance. Therefore, we aimed to compare two methods of bolus and intermittent feeding on enteral feeding intolerance of patients with sepsis.

METHODS

This triple-blind randomized controlled trial was conducted on 60 patients with sepsis, who were fed through tubes for at least 3 days. The patients were randomly assigned into bolus feeding, intermittent feeding, and control groups. Enteral feeding intolerance of all patients was recorded in 3 consecutive days by a researcher-made checklist including the data on gastric residual volume, vomiting, diarrhea, constipation, and abdominal distension.

RESULTS

There were no significant differences between the three studied groups in none of the intervention days pertaining to constipation, diarrhea, vomiting, abdominal distention, and gastric residual volume (p > 0.05). Also, no statistically significant difference was found between all variables in the three studied groups during the 3 days (p > 0.05).

CONCLUSION

As enteral feeding intolerance of patients with sepsis was similar in both bolus and intermittent feeding methods, it can be concluded that bolus method can still be used as a standard method to decrease the risk of enteral feeding intolerance if it is used properly

Influence of gastric fluid reinfusion on enteral nutrition support in intensive care unit patients

AIM: To investigate the influence of gastric juice reinfusion on the effect of early enteral nutrition in intensive care unit (ICU) patients.

METHODS: Eighty patients with enteral nutritional support in ICU of our hospital were randomly divided into an observation group and a control group, with 40 cases in each group. Patients of two groups were both given enteral nutrition, and their gastric juice were collected with a nasogastric tube. In the observation group, the gastric juice after filtration with sterile gauze was reinfused to the jejunum via the nasogastric tube. The control group was given normal saline. Nutritional support related indicators such as serum albumin, plasma total protein and hemoglobin levels were compared in the two groups, and the qualification rate of nutritional support was evaluated. Complications in the two groups were observed and compared.

RESULTS: Serum albumin, serum total protein and hemoglobin levels were significantly improved in the two groups after enteral nutrition (P < 0.05), and the improvement of the observation group was better than that of the control group (P < 0.05). The qualification rate of nutritional support in the observation group was 97.5%, significantly higher than that of the control group (82.5%, P < 0.05). The incidences of abdominal distension, diarrhea, constipation, vomiting and electrolyte imbalance in the observation group were significantly lower than those of the control group (P < 0.05). Length of ICU stay and costs in the observation group were significantly shorter (less) than those of the control group (P < 0.05).

CONCLUSION: Gastric fluid reinfusion can significantly improve the effect of enteral nutrition in ICU patients, and it reduces the incidence of gastrointestinal dysfunctions such as diarrhea, abdominal distension and vomiting.