Prospective randomized control trial of intermittent versus continuous gastric feeds for critically ill trauma patients

Jana B A MacLeod, Jennifer Lefton, Doug Houghton, Christina Roland, James Doherty, Stephen M. Cohn, Erik S. Barquist

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

BACKGROUND: This study compared an intermittent feeding regimen (one-sixth of daily needs infused every 4 hours) with a continuous (drip) feeding regimen for critically ill trauma patients. There were two outcome variables: time to reach goal volume and the days on 100% of caloric needs via an enteral route in the first 10 days of the intensive care unit stay. Adverse events were also tallied. METHODS: A prospective randomized trial was conducted in the trauma intensive care unit in a university Level I trauma center. A total of 164 trauma patients, 18 years of age and older were admitted to the trauma intensive care unit with a noninjured gastrointestinal tract and required more than 48 hours of mechanical ventilation. Patients were randomized to receive enteral nutrition via an intermittent feeding regimen versus a continuous feeding regimen. A single nutritionist calculated caloric and protein goals. A strict protocol was followed where hourly enteral intake, interruptions and their causes, diarrhea, and pneumonia were recorded, as well as standard guidelines for intolerance. RESULTS: A total of 164 patients were randomized and 139 reached their calculated nutritional goal within 7 days. There were no statistical differences in complications of tube feeding. The patients intermittently fed reached the goal faster and by day 7 had a higher probability of being at goal than did the patients fed continuously (χ = 6.01, p = 0.01). Intermittent patients maintained 100% of goal for 4 of 10 days per patient (95% CI = 3.5-4.4) as compared with the drip arm goal for only 3 of 10 days per patient (95% CI = 2.7-3.6). CONCLUSIONS: Patients from both the intermittent and continuous feeding regimens reached the goal during the study period of 7 days but the intermittent regimen patients reached goal enteral calories earlier. The intermittent gastric regimen is logistically simple and has equivalent outcomes to a standard drip-feeding regimen.

Original languageEnglish (US)
Pages (from-to)57-61
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume63
Issue number1
DOIs
StatePublished - Jul 2007

Fingerprint

Critical Illness
Stomach
Wounds and Injuries
Small Intestine
Intensive Care Units
Enteral Nutrition
Nutritionists
Trauma Centers
Artificial Respiration
Gastrointestinal Tract
Diarrhea
Pneumonia
Guidelines

Keywords

  • Critical illness
  • Enteral feeding
  • Human
  • Nutrition
  • Outcome
  • Randomized prospective clinical trial
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Prospective randomized control trial of intermittent versus continuous gastric feeds for critically ill trauma patients. / MacLeod, Jana B A; Lefton, Jennifer; Houghton, Doug; Roland, Christina; Doherty, James; Cohn, Stephen M.; Barquist, Erik S.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 63, No. 1, 07.2007, p. 57-61.

Research output: Contribution to journalArticle

MacLeod, Jana B A ; Lefton, Jennifer ; Houghton, Doug ; Roland, Christina ; Doherty, James ; Cohn, Stephen M. ; Barquist, Erik S. / Prospective randomized control trial of intermittent versus continuous gastric feeds for critically ill trauma patients. In: Journal of Trauma - Injury, Infection and Critical Care. 2007 ; Vol. 63, No. 1. pp. 57-61.
@article{f1a65c2127e74c65b51da4a43f9c6458,
title = "Prospective randomized control trial of intermittent versus continuous gastric feeds for critically ill trauma patients",
abstract = "BACKGROUND: This study compared an intermittent feeding regimen (one-sixth of daily needs infused every 4 hours) with a continuous (drip) feeding regimen for critically ill trauma patients. There were two outcome variables: time to reach goal volume and the days on 100{\%} of caloric needs via an enteral route in the first 10 days of the intensive care unit stay. Adverse events were also tallied. METHODS: A prospective randomized trial was conducted in the trauma intensive care unit in a university Level I trauma center. A total of 164 trauma patients, 18 years of age and older were admitted to the trauma intensive care unit with a noninjured gastrointestinal tract and required more than 48 hours of mechanical ventilation. Patients were randomized to receive enteral nutrition via an intermittent feeding regimen versus a continuous feeding regimen. A single nutritionist calculated caloric and protein goals. A strict protocol was followed where hourly enteral intake, interruptions and their causes, diarrhea, and pneumonia were recorded, as well as standard guidelines for intolerance. RESULTS: A total of 164 patients were randomized and 139 reached their calculated nutritional goal within 7 days. There were no statistical differences in complications of tube feeding. The patients intermittently fed reached the goal faster and by day 7 had a higher probability of being at goal than did the patients fed continuously (χ = 6.01, p = 0.01). Intermittent patients maintained 100{\%} of goal for 4 of 10 days per patient (95{\%} CI = 3.5-4.4) as compared with the drip arm goal for only 3 of 10 days per patient (95{\%} CI = 2.7-3.6). CONCLUSIONS: Patients from both the intermittent and continuous feeding regimens reached the goal during the study period of 7 days but the intermittent regimen patients reached goal enteral calories earlier. The intermittent gastric regimen is logistically simple and has equivalent outcomes to a standard drip-feeding regimen.",
keywords = "Critical illness, Enteral feeding, Human, Nutrition, Outcome, Randomized prospective clinical trial, Trauma",
author = "MacLeod, {Jana B A} and Jennifer Lefton and Doug Houghton and Christina Roland and James Doherty and Cohn, {Stephen M.} and Barquist, {Erik S.}",
year = "2007",
month = "7",
doi = "10.1097/01.ta.0000249294.58703.11",
language = "English (US)",
volume = "63",
pages = "57--61",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Prospective randomized control trial of intermittent versus continuous gastric feeds for critically ill trauma patients

AU - MacLeod, Jana B A

AU - Lefton, Jennifer

AU - Houghton, Doug

AU - Roland, Christina

AU - Doherty, James

AU - Cohn, Stephen M.

AU - Barquist, Erik S.

PY - 2007/7

Y1 - 2007/7

N2 - BACKGROUND: This study compared an intermittent feeding regimen (one-sixth of daily needs infused every 4 hours) with a continuous (drip) feeding regimen for critically ill trauma patients. There were two outcome variables: time to reach goal volume and the days on 100% of caloric needs via an enteral route in the first 10 days of the intensive care unit stay. Adverse events were also tallied. METHODS: A prospective randomized trial was conducted in the trauma intensive care unit in a university Level I trauma center. A total of 164 trauma patients, 18 years of age and older were admitted to the trauma intensive care unit with a noninjured gastrointestinal tract and required more than 48 hours of mechanical ventilation. Patients were randomized to receive enteral nutrition via an intermittent feeding regimen versus a continuous feeding regimen. A single nutritionist calculated caloric and protein goals. A strict protocol was followed where hourly enteral intake, interruptions and their causes, diarrhea, and pneumonia were recorded, as well as standard guidelines for intolerance. RESULTS: A total of 164 patients were randomized and 139 reached their calculated nutritional goal within 7 days. There were no statistical differences in complications of tube feeding. The patients intermittently fed reached the goal faster and by day 7 had a higher probability of being at goal than did the patients fed continuously (χ = 6.01, p = 0.01). Intermittent patients maintained 100% of goal for 4 of 10 days per patient (95% CI = 3.5-4.4) as compared with the drip arm goal for only 3 of 10 days per patient (95% CI = 2.7-3.6). CONCLUSIONS: Patients from both the intermittent and continuous feeding regimens reached the goal during the study period of 7 days but the intermittent regimen patients reached goal enteral calories earlier. The intermittent gastric regimen is logistically simple and has equivalent outcomes to a standard drip-feeding regimen.

AB - BACKGROUND: This study compared an intermittent feeding regimen (one-sixth of daily needs infused every 4 hours) with a continuous (drip) feeding regimen for critically ill trauma patients. There were two outcome variables: time to reach goal volume and the days on 100% of caloric needs via an enteral route in the first 10 days of the intensive care unit stay. Adverse events were also tallied. METHODS: A prospective randomized trial was conducted in the trauma intensive care unit in a university Level I trauma center. A total of 164 trauma patients, 18 years of age and older were admitted to the trauma intensive care unit with a noninjured gastrointestinal tract and required more than 48 hours of mechanical ventilation. Patients were randomized to receive enteral nutrition via an intermittent feeding regimen versus a continuous feeding regimen. A single nutritionist calculated caloric and protein goals. A strict protocol was followed where hourly enteral intake, interruptions and their causes, diarrhea, and pneumonia were recorded, as well as standard guidelines for intolerance. RESULTS: A total of 164 patients were randomized and 139 reached their calculated nutritional goal within 7 days. There were no statistical differences in complications of tube feeding. The patients intermittently fed reached the goal faster and by day 7 had a higher probability of being at goal than did the patients fed continuously (χ = 6.01, p = 0.01). Intermittent patients maintained 100% of goal for 4 of 10 days per patient (95% CI = 3.5-4.4) as compared with the drip arm goal for only 3 of 10 days per patient (95% CI = 2.7-3.6). CONCLUSIONS: Patients from both the intermittent and continuous feeding regimens reached the goal during the study period of 7 days but the intermittent regimen patients reached goal enteral calories earlier. The intermittent gastric regimen is logistically simple and has equivalent outcomes to a standard drip-feeding regimen.

KW - Critical illness

KW - Enteral feeding

KW - Human

KW - Nutrition

KW - Outcome

KW - Randomized prospective clinical trial

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=34447327285&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34447327285&partnerID=8YFLogxK

U2 - 10.1097/01.ta.0000249294.58703.11

DO - 10.1097/01.ta.0000249294.58703.11

M3 - Article

C2 - 17622869

AN - SCOPUS:34447327285

VL - 63

SP - 57

EP - 61

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 1

ER -