Abstract
Objective: The goal of this study is to compare sequential feeding and continuous feeding on blood glucose of critically ill patients. Methods: A non-inferiority randomized controlled trail was adopted in this study. A total of 62 patients were finally enrolled, who were fed with enteral nutritional suspension through gastric tubes. After achieving 80% of the nutrition target calories (25kcal/kg/d) through continuous feeding, the patients were then randomly assigned into sequential feeding and continuous feeding group. In sequential feeding group, the feeding/fasting time was reasonably determined, according to the circadian rhythm of the human body in traditional Chinese medicine theory. The total daily dosage of enteral nutritional suspension was equally distributed to the three time periods of 7-9 o 'clock, 11-13 o 'clock and 17-19 o 'clock. Enteral nutritional suspension in each time period was pumped at a uniform rate within two hours by enteral feeding pump. While in continuous feeding group, patients received continuous feeding with constant velocity by enteral feeding pump during the study. Blood glucose values at 5 points (6:00/11:00/15:00/21:00/1:00) were monitored and recorded in 7 consecutive days after randomization. Meanwhile, enteral feeding intolerance was also recorded. Results: No significant demographic or physiologic differences between the sequential feeding and continuous feeding group (P >0.05). The average of glucose in sequential feeding was no inferior to continuous feeding [8.8(7.3-10.3) mmol/L vs. 10.7(9.1-12.1) mmol/L, P for non-inferiority =0.038). Hyperglycemia in CF group was more often than SF group (36.1% vs. 23.0%, P＜0.01). There was no significant differences in glucose standard deviations and Glucosemax -Glucosemin between two groups (P＞0.05). But the coefficient of glucose variation in sequential feeding group was higher than continuous feeding group [24.5(22.2-27.6) % vs. 18.9(13.7-25.3) %, P=0.013). Moreover, no significant difference in the incidence of feeding intolerance during the 7 days were found (P> 0.05). Conclusions: In this non-inferiority study, average blood glucose value of critically ill patients with sequential feeding was not higher than continuous feeding. And the feeding intolerance in sequential feeding was similar to continuous feeding.
When and how to manage enteral feeding intolerance?
