Intermittent Feeding in Critically Ill Patients

Editorial

16 October 2023

Editorial: Intermittent feeding in critically ill patients

Cristian Deana

Pietro Vecchiarelli

Edoardo Picetti

and

Alessio Molfino

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0 citations

Editors

Pietro Vecchiarelli

Azienda Sanitaria Locale di Viterbo

CRISTIAN DEANA

Azienda Sanitaria Universitaria Integrata di Udine

Alessio Molfino

Sapienza University of Rome

Edoardo Picetti

University Hospital of Parma

Impact

Forest plot showing the difference between intermittent versus continuous enteral feeding for (A) mortality in ICU, (B) length of ICU stay, (C) achievement of nutritional goal.

Systematic Review

21 August 2023

The effect of intermittent versus continuous enteral feeding for critically ill patients: a meta-analysis of randomized controlled trials

Jing Qu

, 4 more and

Leshuang Hu

Objectives: The appropriate strategy for enteral feeding in critically ill patients still remains controversial. Therefore, we conducted this meta-analysis to compare the effect of intermittent versus continuous enteral feeding method for critically ill patients.

Methods: Electronic databases including PubMed, Embase, Scopus, and Cochrane Library were searched up to April 10th, 2023 for randomized controlled trials evaluating the effect of intermittent versus continuous enteral feeding for critically ill patients. The primary outcomes were feeding intolerances, including diarrhea, vomiting, distension, constipation, gastric retention, and aspiration pneumonia. The secondary outcomes were mortality in intensive care unit (ICU), length of stay in ICU, and achievement of nutritional goal.

Results: Thirteen studies with a total of 884 patients were analyzed in this meta-analysis. Overall, the use of intermittent enteral feeding was associated with higher incidence of diarrhea (OR 1.66, 95%CI 1.13 to 2.43, I² = 16%) and distension (OR 2.29, 95%CI 1.16 to 4.51, I² = 0%), lower incidence of constipation (OR 0.58, 95%CI 0.37 to 0.90, I² = 0%), and longer length of ICU stay (MD 1.09, 95%CI 0.53 to 1.64, I² = 0%). Moreover, no significant difference was identified for other outcome measures.

Conclusion: In critically ill patients, the implementation of intermittent enteral feeding was associated with higher incidence of diarrhea and distension, longer length of ICU stay, but lower occurrence of constipation. Nevertheless, the absence of sufficient high-quality randomized controlled clinical trials precludes any definitive conclusions regarding the optimal approach to enteral feeding in this population. There is an imperative need for more studies to further assess the efficacy of the two enteral feeding strategies.

3,661 views

6 citations

Original Research

04 April 2023

Potential benefits of vitamin D for sepsis prophylaxis in critical ill patients

Jianbin Guan

, 8 more and

Zhanguo Liu

Background: Vitamin D deficiency is common in critically ill patients with suspected infection and is strongly associated with the predisposition of sepsis and a poor prognosis. The effectiveness of vitamin D supplementation for preventing sepsis remains unclear. This retrospective cohort study investigated the effect of vitamin D supplementation on sepsis prophylaxis in critically ill patients with suspected infection.

Methods: This retrospective cohort study included 19,816 adult patients with suspected infection in intensive care units (ICU) from 2008 to 2019 at the Beth Israel Deaconess Medical Center, Boston, USA. The included patients were divided into the vitamin D cohort or non-vitamin D cohort according to vitamin D administration status. The primary outcomes were the incidence of sepsis in ICU. The secondary outcomes included 28-day all-cause mortality, length of ICU and hospital stay and the requirements of vasopressors or mechanical ventilation. A propensity score matching cohort was used to test the differences in primary and secondary outcomes between groups.

Results: The results showed that vitamin D supplementation demonstrated a lower risk of sepsis (odd ratio 0.46; 95% CI 0.35–0.60; P < 0.001) and a lower risk of new mechanical ventilation requirement (odd ratio 0.70; 95% CI 0.53-0.92; P = 0.01), but no significant difference in the risk of 28-day mortality was observed (hazard ratio 1.02; 95% CI 0.77–1.35; P = 0.89). In the sensitive analysis, among the patients who suspected infection within 24 h before or after ICU admission, a lower risk of sepsis and a lower percentage of new mechanical ventilation also were detected in the vitamin D cohort.

Conclusion: Vitamin D supplementation may have a positively prophylactic effect on sepsis in critically ill patients with suspected infection.

4,197 views

6 citations

Systematic Review

03 August 2023

Effect of intravenous vitamin C on adult septic patients: a systematic review and meta-analysis

Huoyan Liang

, 7 more and

Tongwen Sun

2,270 views

0 citations

Original Research

22 March 2023

Neurological impairment and malnutrition in children: The role of home enteral nutrition in real life

Antonella Diamanti

, 12 more and

Giuseppe Maggiore

GERD results correlate with EN formula (p = 0.03), but not with mixed diet (p = 0.05). Polymeric formulas showed the highest correlation with GERD (R = 0.32), followed by AA based (R = 0.27) and hydrolyzed formulas (R = 0.24). Constipation and OPD were significantly correlated with mixed diet (p = 0.04, R = 0.26, and p = 0.02, R = 0.32, respectively).

Objective: Recent decades have brought an increased survival of children with Neurologic Impairment (NI) but malnutrition and digestive comorbidity remain important challenges to face. We designed the present study to assess the course of nutritional status following standardized Home Enteral Nutrition (HEN) program and to evaluate impact of changing mode of feeding, as a part of overall multidisciplinary management, on digestive co-morbidity as Gastro-Esophageal Reflux Disease (GERD), Oropharyngeal Dysphagia (OPD), constipation and airway aspiration.

Methods: We performed a retrospective analysis on NI children entered into Institutional HEN program due to NI disorders between January 2011 and 2019. Demographic, anthropometric characteristics (BMI z-score and weight for age z-score) and symptoms (GERD, OPD constipation and airway aspiration) were collected at the enrolment and during the follow up.

Results: We enrolled 402 patients (median age: 39 months); overall survival was 97%. Nutritional status was significantly improved by HEN; in particular growth profile significantly changed within the first 2 years following HEN beginning; GERD and airways aspirations decreased after HEN beginning. Constipation and OPD remained unchanged over time.

Conclusions: Malnutrition and digestive complaints are distinctive features of NI children. Nutritional status improve after 2 years from the beginning of standardized nutritional interventions. Overall multidisciplinary care, including standardized HEN protocols, seems to also impact on GERD and airway aspirations, which can decrease over time. It is possible that constipation and OPD, unchanged over time, are more dependent on underlying diseases than on overall treatments.

2,454 views

4 citations