Prospective randomized control trial of intermittent versus continuous gastric feeds for critically ill trauma patients.
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.
MacLeod
Jana B A
JB
Department of Surgery, Emory University, Atlanta, Georgia, USA.
Lefton
Jennifer
J
Houghton
Doug
D
Roland
Christina
C
Doherty
James
J
Cohn
Stephen M
SM
Barquist
Erik S
ES
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*