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Bolus vs Continuous Nasogastric Feeds in Mechanically Ventilated Pediatric Patients: A Pilot Study
Ann-Marie Brown1,2, Elaine Fisher1,3, Michael L Forbes2
1Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.
Insights
Bolus gastric feeding (B-GF) in pediatric intensive care units (PICU) delivered nutrition faster and more effectively than continuous gastric feeding (C-GF) without increasing aspiration risks. This finding supports B-GF as a safe and efficient method for critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Clinical Nutrition
- Gastroenterology
Background:
- Malnutrition is a significant risk factor for mortality and morbidity in pediatric intensive care units (PICUs).
- Challenges in delivering adequate enteral nutrition (EN) include hemodynamic instability, feeding interruptions, intolerance, and lack of standardized protocols.
- Current guidelines highlight a lack of evidence regarding optimal EN delivery methods for critically ill children.
Purpose of the Study:
- To compare the effectiveness and safety of continuous gastric feeding (C-GF) versus bolus gastric feeding (B-GF) in intubated pediatric patients.
- To evaluate the impact of B-GF on energy and protein delivery and time to goal volume.
- To assess the incidence of aspiration events and associated lung injury in both feeding groups.
Main Methods:
- Randomized enrollment of pediatric patients (1 month-12 years) who were intubated within 24 hours and initiated EN within 48 hours of PICU admission.
- Patients were assigned to either C-GF or B-GF groups, with goal-directed EN volume and caloric density escalated over time.
- Data on feeding interruptions, intolerance events, aspiration, and lung injury were systematically recorded.
Main Results:
- Twenty-five subjects were enrolled (11 B-GF, 14 C-GF).
- B-GF demonstrated significantly higher energy and protein delivery at 24 hours (P < 0.007) and a faster median time to reach goal volume (15 hours for B-GF vs. 29.5 hours for C-GF).
- No aspiration events leading to additional lung injury were observed in either group (P = 0.866).
Conclusions:
- Bolus gastric feeding (B-GF) is associated with superior enteral nutrition delivery compared to continuous gastric feeding (C-GF) in intubated pediatric patients.
- B-GF demonstrated a comparable safety profile to C-GF, with no increased risk of aspiration-related lung injury.
- Further research is warranted to evaluate B-GF in diverse PICU populations.
Background:
Malnutrition increases the risk of mortality and morbidity in the pediatric intensive care unit (PICU). Barriers to adequate delivery of enteral nutrition (EN) include hemodynamic instability, feeding interruptions and intolerance, and lack of standardized feeding protocols. The most recent guidelines on nutrition support for the critically ill child describe a paucity of evidence around the best method to deliver EN. There is an untested clinical assumption that bolus gastric feeding (B-GF) in intubated patients is associated with aspiration events, lung injury, and associated morbidity compared with continuous gastric feeding (C-GF). This study compared the effectiveness and safety of C-GF vs B-GF in intubated pediatric patients.
Methods:
We enrolled randomized patients aged 1 month-12 years who were intubated within 24 hours and received EN starting within 48 hours of admission to a C-GF or B-GF group. Goal-directed EN volume and caloric density were increased every 3 and 12 hours, respectively, to target. Feeding interruptions and intolerance events were recorded.
Results:
Twenty-five subjects were enrolled (B-GF = 11; C-GF = 14). At 24 hours, B-GF was associated with higher energy and protein delivery (P < 0.007) and was associated with faster time to goal volume (median B-GF = 15 hours; C-GF = 29.5 hours). No aspiration events resulting in additional lung injury were noted for either group (P = 0.866).
Conclusions:
B-GF was associated with superior delivery of EN with a comparable safety profile to C-GF. Further study is needed to compare both EN methods in other PICU populations.
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