Intermittent feeding in intensive care – the theory and practice

Introduction: Nutrition therapy becomes one of the fundamental conditions of a successful outcome in malnourished patients and in critically ill patients. The administration of enteral feeding in critically ill patients is mostly performed by continuous or cyclic feeding. On the contrary, the potential benefits of intermittent feeding include increased muscle protein synthesis. This review outlines the theory of a possible anabolic effect of intermittent feeding. The authors describe their experience with implementation of this method of administration in the intensive care unit including the follow-up of possible complications and adverse effects. Methods: Six patients with intermittent feeding were followed retrospectively during the study period. In addition to demographic data, potential complications related to intermittent enteral feeding (aspiration pneumonia, increased gastric residual volume, abdominal discomfort, osmotic diarrhoea) were evaluated. Results: The average time of intermittent feeding was 8 days. The sum of intermittent feeding days was 63. No aspiration followed by pneumonia was detected during this period. The gastric residual volume did not increase, either. Abdominal discomfort and osmotic diarrhoea were not observed in any patient. Conclusion: Although continuous and cyclic enteral feeding in critically ill patients remains the standard and the most common practice, it is considered as a non-physiological method with possible negative consequences for the patient. On the other hand, intermittent feeding is theoretically associated with respecting of the circadian rhythm and with activation of autophagy. Intermittent feeding increases muscle protein synthesis and supports the release of fatty acids. As shown by our observational study, intermittent administration of enteral nutrition in intensive care can be implemented without any adverse effects; however, it is more time consuming for the nurses.

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Protein delivery in intermittent and continuous enteral nutrition with a protein-rich formula in critically ill patients - A protocol for the prospective randomised controlled proof-of-concept Protein Bolus Nutrition (Pro BoNo) study

10.21203/rs.2.23374/v3 ◽

2020 ◽

Author(s):

Simona Reinhold ◽

Désirée Yeginsoy ◽

Alexa Hollinger ◽

Atanas Todorov ◽

Lionel Tintignac ◽

...

Keyword(s):

Protein Synthesis ◽

Critically Ill ◽

Enteral Feeding ◽

Critically Ill Patients ◽

Muscle Wasting ◽

Muscle Protein ◽

Muscle Protein Synthesis ◽

Secondary Outcome ◽

Pro Bono ◽

Randomised Controlled

Abstract Background Critically ill patients rapidly develop muscle wasting resulting in sarcopenia, long-term disability and higher mortality. Bolus nutrition (30-60 min period), while having a similar incidence of aspiration as continuous feeding, seems to provide metabolic benefits through increased muscle protein synthesis due to higher leucine peaks. To date, clinical evidence on achievement of nutritional goals and influence of bolus nutrition on skeletal muscle metabolism in ICU patients is lacking. The aim of the Pro BoNo study (Protein Bolus Nutrition) is to compare intermittent and continuous enteral feeding with a specific high-protein formula. We hypothesise that target quantity of protein is reached earlier (within 36 hours) by an intermittent feeding protocol with a favourable influence on muscle protein synthesis.Methods Pro BoNo is a prospective randomised controlled study aiming to compare the impact of intermittent and continuous enteral feeding on preventing muscle wasting in 60 critically ill patients recruited during the first 48 hours after ICU admission. The primary outcome measure is the time until the daily protein target (≥1.5 g protein/kg bodyweight/24h) is achieved. Secondary outcome measures include tolerance of enteral feeding and evolution of glucose, urea and IGF-1. Ultrasound and muscle biopsy of the quadriceps will be performed.Discussion The Basel Pro BoNo study aims to collect innovative data on the effect of intermittent enteral feeding of critically ill patients on muscle wasting.Trial registration ClinicalTrials.gov Identifier: NCT03587870, registered July 16, 2018. Swiss National Clinical Trial Portal identifier: SNCTP000003234, last updated July 24, 2019.

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Protein delivery in intermittent and continuous enteral nutrition with a protein-rich formula in critically ill patients - A protocol for the prospective randomised controlled proof-of-concept Protein Bolus Nutrition (Pro BoNo) study

10.21203/rs.2.23374/v1 ◽

2020 ◽

Author(s):

Simona Reinhold ◽

Désirée Yeginsoy ◽

Alexa Hollinger ◽

Atanas Todorov ◽

Lionel Tintignac ◽

...

Keyword(s):

Protein Synthesis ◽

Critically Ill ◽

Enteral Feeding ◽

Critically Ill Patients ◽

Muscle Wasting ◽

Muscle Protein ◽

Muscle Protein Synthesis ◽

Secondary Outcome ◽

Pro Bono ◽

Randomised Controlled

Abstract Background Critically ill patients rapidly develop muscle wasting resulting in sarcopenia, long-term disability and higher mortality. Bolus nutrition (30-60 min period), while having a similar incidence of aspiration as continuous feeding, seems to provide metabolic benefits through increased muscle protein synthesis due to higher leucine peaks. To date, clinical evidence on achievement of nutritional goals and influence of bolus nutrition on skeletal muscle metabolism in ICU patients is lacking. The aim of the Pro BoNo study ( Pro tein Bo lus N utriti o n) is to compare intermittent and continuous enteral feeding with a specific high-protein formula. We hypothesise that target quantity of protein is reached earlier (within 36 hours) by an intermittent feeding protocol with a favourable influence on muscle protein synthesis. Methods Pro BoNo is a prospective randomised controlled study aiming to compare the impact of intermittent and continuous enteral feeding on preventing muscle wasting in 60 critically ill patients recruited during the first 48 hours after ICU admission. The primary outcome measure is the time until the daily protein target (≥1.5 g protein/kg bodyweight/24h) is achieved. Secondary outcome measures include tolerance of enteral feeding and trajectory of glucose, urea and IGF-1. Ultrasound and muscle biopsy of the quadriceps will be performed. Discussion The Basel Pro BoNo study aims to collect innovative data on the effect of intermittent enteral feeding of critically ill patients on muscle wasting.

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Protein delivery in intermittent and continuous enteral nutrition with a protein-rich formula in critically ill patients - A protocol for the prospective randomised controlled proof-of-concept Protein Bolus Nutrition (Pro BoNo) study

10.21203/rs.2.23374/v2 ◽

2020 ◽

Author(s):

Simona Reinhold ◽

Désirée Yeginsoy ◽

Alexa Hollinger ◽

Atanas Todorov ◽

Lionel Tintignac ◽

...

Keyword(s):

Protein Synthesis ◽

Critically Ill ◽

Enteral Feeding ◽

Critically Ill Patients ◽

Muscle Wasting ◽

Muscle Protein ◽

Muscle Protein Synthesis ◽

Secondary Outcome ◽

Pro Bono ◽

Randomised Controlled

Abstract Background Critically ill patients rapidly develop muscle wasting resulting in sarcopenia, long-term disability and higher mortality. Bolus nutrition (30-60 min period), while having a similar incidence of aspiration as continuous feeding, seems to provide metabolic benefits through increased muscle protein synthesis due to higher leucine peaks. To date, clinical evidence on achievement of nutritional goals and influence of bolus nutrition on skeletal muscle metabolism in ICU patients is lacking. The aim of the Pro BoNo study (Protein Bolus Nutrition) is to compare intermittent and continuous enteral feeding with a specific high-protein formula. We hypothesise that target quantity of protein is reached earlier (within 36 hours) by an intermittent feeding protocol with a favourable influence on muscle protein synthesis. Methods Pro BoNo is a prospective randomised controlled study aiming to compare the impact of intermittent and continuous enteral feeding on preventing muscle wasting in 60 critically ill patients recruited during the first 48 hours after ICU admission. The primary outcome measure is the time until the daily protein target (≥1.5 g protein/kg bodyweight/24h) is achieved. Secondary outcome measures include tolerance of enteral feeding and evolution of glucose, urea and IGF-1. Ultrasound and muscle biopsy of the quadriceps will be performed. Discussion The Basel Pro BoNo study aims to collect innovative data on the effect of intermittent enteral feeding of critically ill patients on muscle wasting. Trial registration ClinicalTrials.gov Identifier: NCT03587870, registered July 16, 2018. Swiss National Clinical Trial Portal identifier: SNCTP000003234, last updated July 24, 2019.

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Evaluation of the effect on patient parameters of not monitoring gastric residual volume in intensive care patients on a mechanical ventilator receiving enteral feeding: A randomized clinical trial

Journal of Critical Care ◽

10.1016/j.jcrc.2016.01.028 ◽

2016 ◽

Vol 33 ◽

pp. 137-144 ◽

Cited By ~ 22

Author(s):

Nurten Ozen ◽

Nuran Tosun ◽

Levent Yamanel ◽

Neriman Defne Altintas ◽

Guldem Kilciler ◽

...

Keyword(s):

Clinical Trial ◽

Intensive Care ◽

Randomized Clinical Trial ◽

Enteral Feeding ◽

Mechanical Ventilator ◽

Residual Volume ◽

Gastric Residual Volume ◽

Intensive Care Patients

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PT01.1: The Effects of Applying Gastric Residual Volume Management Protocol(GRVMP) in Critically Ill Patients

Clinical Nutrition ◽

10.1016/s0261-5614(19)32541-5 ◽

2019 ◽

Vol 38 ◽

pp. S33

Author(s):

C.H. Lee ◽

S.K. Peak ◽

K.H. Park ◽

Y.S. Jang ◽

C.S. Shin ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Residual Volume ◽

Gastric Residual Volume ◽

Volume Management ◽

Management Protocol

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590 What Is the Most Appropriate Gastric Residual Volume to Identify Delayed Gastric Emptying in Critically Ill Patients?

Gastroenterology ◽

10.1016/s0016-5085(08)60380-7 ◽

2008 ◽

Vol 134 (4) ◽

pp. A-81

Author(s):

Nam Q. Nguyen ◽

Katrina Ching ◽

Robert J. Fraser ◽

Ross N. Butler ◽

Richard H. Holloway

Keyword(s):

Gastric Emptying ◽

Critically Ill ◽

Critically Ill Patients ◽

Delayed Gastric Emptying ◽

Residual Volume ◽

Gastric Residual Volume

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Literature Study: The Effect of Abdominal Massage to Reduce Gastric Residual Volume in Critically Ill Patients

Jurnal Ilmu Keperawatan (Journal of Nursing Science) ◽

10.21776/ub.jik.2021.009.02.1 ◽

2013 ◽

Vol 9 (2) ◽

pp. 143-150

Author(s):

Adella Indri Afitasari ◽

◽

Dian Hudiyawati

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Cost Effective ◽

Abdominal Distension ◽

Abdominal Pressure ◽

Residual Volume ◽

Gastric Residual Volume ◽

Gastrointestinal Dysfunction ◽

Literature Study ◽

Abdominal Massage

Gastrointestinal dysfunction is one of the most common problems experienced by patients in the ICU, such as abdominal distension, constipation, and increased gastric residual volume. Currently, non-pharmacological interventions have been developed to address these problems. Abdominal massage intervention is considered a method that can improve digestive function. The purpose of this literature study was to determine the effect of abdominal massage to reduce the gastric residual volume in critically ill patients. Selected articles were obtained through online databases such as PubMed, Google Scholar, and ScienceDirect. There were seven articles obtained after going through screening and identified for critical review. There were five study randomized controlled trials, three quasi-experimental designs, one study, one group pre-test post-test, and one article one-shot case study. The results of this study found that abdominal massage was effective in reducing gastric residual volume. Mechanism of abdominal massage with stimulation of peristalsis, changes in intra-abdominal pressure, mechanical and reflexive effects on the intestine, thereby shortening the transition time of food in the intestine, increasing bowel movements, and easier flow of food through the digestive tract. So that nurses in the ICU are expected to use abdominal massage as an intervention option at critical times, considering that this intervention can prevent gastrointestinal dysfunction with low risk and is cost-effective.

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