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 (chi = 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.
authors.affiliation: Department of Surgery, Emory University, Atlanta, Georgia, USA.
authors.forename: Jana B A
authors.initials: JB
authors.lastname: MacLeod
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lefton
authors.forename: Doug
authors.initials: D
authors.lastname: Houghton
authors.forename: Christina
authors.initials: C
authors.lastname: Roland
authors.forename: James
authors.initials: J
authors.lastname: Doherty
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Cohn
authors.forename: Erik S
authors.initials: ES
authors.lastname: Barquist
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014947:Wounds and Injuries / Q000628:therapy*