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Review
. 2023 Aug 21:10:1214774.
doi: 10.3389/fnut.2023.1214774. eCollection 2023.

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

Jing Qu  1 , Xiaoya Xu  1 , Chaobo Xu  1 , Xuzhong Ding  1 , Kai Zhang  2 , Leshuang Hu  1
Affiliations
Review

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

Jing Qu et al. Front Nutr. .

Abstract

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.

Keywords: continuous feeding strategy; critically ill; enteral nutrition; intermittent feeding strategy; meta - analysis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA 2020 flow diagram for the meta-analysis.
Figure 2
Figure 2
Assessment of quality by the Cochrane risk of bias tool.
Figure 3
Figure 3
Forest plot showing the difference between intermittent versus continuous enteral feeding for (A) diarrhea, (B) vomiting, and (C) distension.
Figure 4
Figure 4
Forest plot showing the difference between intermittent versus continuous enteral feeding for (A) constipation, (B) gastric retention, and (C) aspiration pneumonia.
Figure 5
Figure 5
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.
See this image and copyright information in PMC

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