Bolus gastric feeds improve nutrition delivery to mechanically ventilated pediatric medical patients: Results of the COntinuous vs BOlus multicenter trial

Ann-Marie Brown^{1

2

3}, Sharon Y Irving⁴, Charlene Pringle^{5

6}, Christine Allen^{7

8}, Miraides F Brown⁹, Sholeen Nett^{10

11}, Marcy N Singleton^{12

13}, Theresa A Mikhailov^{14

15}, Erik Madsen^{16

17}, Vijay Srinivasan^{18

19}, Heather Anthony³, Michael L Forbes^{20

21

22}; the NutriNet and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

Affiliations

¹ Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.
² Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
³ Akron Children's Hospital, Akron, Ohio, USA.
⁴ Department of Family & Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.
⁵ Division of Pediatric Critical Care Medicine, University of Florida, Florida, USA.
⁶ UFHealth Shands Children's Hospital, Gainesville, Florida, USA.
⁷ Division of Pediatric Critical Care, University of Oklahoma Health Sciences Center, Florida, USA.
⁸ The Children's Hospital at OU Health, Oklahoma City, Oklahoma, USA.
⁹ Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio, USA.
¹⁰ Division of Pediatric Critical Care, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.
¹¹ Baystate Children's Hospital, Springfield, Massachusetts, USA.
¹² Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.
¹³ Pediatrics Geisel School of Medicine, Lebanon, New Hampshire, USA.
¹⁴ Division of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
¹⁵ Children's Wisconsin, Milwaukee, Wisconsin, USA.
¹⁶ Division of Pediatric Critical Care, Saint Louis University School of Medicine, St Louis, Missouri, USA.
¹⁷ Cardinal Glennon Children's Hospital, St Louis, Missouri, USA.
¹⁸ Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
¹⁹ Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
²⁰ Northeast Ohio Medical University, School of Medicine, Rootstown, Ohio, USA.
²¹ Department of Pediatrics, Associate Chair, Akron Children's Hospital, Akron, Ohio, USA.
²² Critical Care Research & Outcomes Analysis, Akron Children's Hospital, Akron, Ohio, USA.

PMID: 34881440
DOI: 10.1002/jpen.2305

Multicenter Study

Bolus gastric feeds improve nutrition delivery to mechanically ventilated pediatric medical patients: Results of the COntinuous vs BOlus multicenter trial

Ann-Marie Brown et al. JPEN J Parenter Enteral Nutr. 2022 Jul.

. 2022 Jul;46(5):1011-1021.

doi: 10.1002/jpen.2305. Epub 2022 Jan 27.

Authors

Affiliations

¹ Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.
² Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
³ Akron Children's Hospital, Akron, Ohio, USA.
⁴ Department of Family & Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.
⁵ Division of Pediatric Critical Care Medicine, University of Florida, Florida, USA.
⁶ UFHealth Shands Children's Hospital, Gainesville, Florida, USA.
⁷ Division of Pediatric Critical Care, University of Oklahoma Health Sciences Center, Florida, USA.
⁸ The Children's Hospital at OU Health, Oklahoma City, Oklahoma, USA.
⁹ Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio, USA.
¹⁰ Division of Pediatric Critical Care, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.
¹¹ Baystate Children's Hospital, Springfield, Massachusetts, USA.
¹² Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.
¹³ Pediatrics Geisel School of Medicine, Lebanon, New Hampshire, USA.
¹⁴ Division of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
¹⁵ Children's Wisconsin, Milwaukee, Wisconsin, USA.
¹⁶ Division of Pediatric Critical Care, Saint Louis University School of Medicine, St Louis, Missouri, USA.
¹⁷ Cardinal Glennon Children's Hospital, St Louis, Missouri, USA.
¹⁸ Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
¹⁹ Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
²⁰ Northeast Ohio Medical University, School of Medicine, Rootstown, Ohio, USA.
²¹ Department of Pediatrics, Associate Chair, Akron Children's Hospital, Akron, Ohio, USA.
²² Critical Care Research & Outcomes Analysis, Akron Children's Hospital, Akron, Ohio, USA.

PMID: 34881440
DOI: 10.1002/jpen.2305

Abstract

Background: Comparison of bolus gastric feeding (BGF) vs continuous gastric feeding (CGF) with respect to timing and delivery of energy and protein in mechanically ventilated (MV) pediatric patients has not been investigated. We hypothesized that bolus delivery would shorten time to goal nutrition and increase the percentage of goal feeds delivered.

Methods: Multicenter, prospective, randomized comparative effectiveness trial conducted in seven pediatric intensive care units (PICUs). Eligibility criteria included patients aged 1 month to 12 years who were intubated within 24 h of PICU admission, with expected duration of ventilation at least 48 h, and who were eligible to begin enteral nutrition within 48 h. Exclusion criteria included patients with acute or chronic gastrointestinal pathology or acute surgery.

Results: We enrolled 158 MV children between October 2015 and April 2018; 147 patients were included in the analysis (BGF = 72, CGF = 75). Children in the BGF group were slightly older than those in the CGF; otherwise, the two groups had similar demographic characteristics. There was no difference in the percentage of patients in each group who achieved goal feeds. Time to goal feeds was shorter in the BGF group (hazard ratio 1.5 [CI 1.02-2.33]; P = 0.0387). Median percentage of target kilocalories (median kcal 0.78 vs 0.59; P ≤ 0.0001) and median percentage of protein delivered (median protein 0.77 vs 0.59; P ≤ 0.0001) was higher for BGF patients. There was no difference in serial oxygen saturation index between groups.

Conclusion: Our study demonstrated shorter time to achieve goal nutrition via BGF compared with CGF in MV pediatric patients. This resulted in increased delivery of target energy and nutrition. Further study is needed in other PICU populations.

Keywords: critical care; enteral nutrition; intensive care units; life cycle; nutrition; pediatric; pediatrics; research and diseases; tube feeding.

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References

REFERENCES

1. Valla FV, Baudin F, Gaillard Le Roux B, et al. Nutritional status deterioration occurs frequently during children's ICU stay. Pediatr Crit Care Med. 2019;20(8):714-721.
1. Mehta NM, Bechard LJ, Cahill N, et al. Nutritional practices and their relationship to clinical outcomes in critically ill children-an international multicenter cohort study*. Crit Care Med. 2012;40(7):2204-2211.
1. Brown AM, Carpenter D, Keller G, Morgan S, Irving SY. Enteral nutrition in the PICU: current status and ongoing challenges. J Pediatr Intensive Care. 2015;4(2):111-120.
1. Schindler CA, Mikhailov TA, Kuhn EM, et al. Protecting fragile skin: nursing interventions to decrease development of pressure ulcers in pediatric intensive care. Am J Crit Care. 2011;20(1):26-35.
1. Mikhailov TA, Kuhn EM, Manzi J, et al. Early enteral nutrition is associated with lower mortality in critically ill children. JPEN J Parenter Enteral Nutr. 2014;38(4):459-466.

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Bolus gastric feeds improve nutrition delivery to mechanically ventilated pediatric medical patients: Results of the COntinuous vs BOlus multicenter trial

Affiliations

Bolus gastric feeds improve nutrition delivery to mechanically ventilated pediatric medical patients: Results of the COntinuous vs BOlus multicenter trial

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Miscellaneous