Intermittent versus continuous feeding in critically ill adults.

Area of Science:

• Critical care medicine
• Nutritional support
• Gastroenterology

Background:

• Early enteral nutrition is recommended for critically ill adult patients.
• The optimal method of enteral nutrition delivery (continuous vs. intermittent) is not well-established.
• Continuous enteral nutrition is the current global standard, but intermittent administration is gaining attention.

Purpose of the Study:

• To compare continuous and intermittent enteral nutrition administration in critically ill adults.
• To outline metabolic responses to different enteral nutrition delivery methods.
• To review recent studies on the outcomes of continuous versus intermittent enteral nutrition.

Main Methods:

• Review of existing literature comparing continuous and intermittent enteral nutrition.
• Analysis of metabolic responses in healthy and critically ill populations.
• Examination of randomized controlled trials on enteral nutrition delivery methods.

Main Results:

• Intermittent nutrition improved whole body protein balance from negative to positive in separate studies of healthy and critically ill individuals.
• In healthy humans, intermittent bolus feeding increased mesenteric blood flow, insulin, and peptide YY, while reducing blood glucose.
• A trial in critically ill patients showed no significant differences in glycemic variability, insulin use, or intake between intermittent and continuous groups.

Conclusions:

• Studies in healthy individuals suggest intermittent nutrition enhances protein synthesis.
• Similar studies are lacking for critically ill patients.
• Further research considering protein quantity, quality, and delivery route is needed before making recommendations for intermittent nutrition in critical care.