The following is a summary of “Comparison of continuous versus intermittent enteral feeding in critically ill patients: a systematic review and meta-analysis,” published in the October 2022 issue of Critical Care by Heffernan, et al.
Patients in critical care often have their nutritional needs met via the enteral route. However, there is a lack of evidence to inform practitioners how best to administer the dose. The most common kind of enteral nutrition is continuous feeding, although there are situations in which a bolus or intermittent approach could be preferable. This systematic review aims to evaluate the relative merits of continuous versus intermittent or bolus enteral nutrition treatment. Studies were identified from the PubMed, EMBASE, Cochrane Library, and Web of Science databases for a meta-analysis and systematic review. All studies comparing continuous enteral feeding to intermittent or bolus administration in adults in the intensive care unit were considered.
Two different quality assessment scales, PEDro and Newcastle-Ottawa, were used to evaluate the studies. Mortality, diarrhea, constipation, increased gastric residuals, pneumonia, and bacterial colonization were all subjected to random-effects meta-analysis, which was carried out with Review Manager. Out of a total of 5,546 articles found, 133 were chosen for a thorough evaluation. In total, 14 were considered for this summary. Patients receiving continuous enteral nutrition had a higher risk of constipation (relative risk 2.24, 95% confidence interval 1.01-4.97, P=0.05). Different outcomes were not distinguished. A significant bias was not found.
To date, no significant differences in clinical relevance have been found in the current meta-analysis of outcome measures for critically ill patients. Unfortunately, high-quality randomized, controlled clinical trials are scarce and cannot be relied upon to direct this choice. Therefore, both dosing schedules might be considered by clinicians, depending on the needs of the individual patient.