Safety of intermittent versus continuous enteral nutrition in critically ill patients. Randomized clinical trial.

INTRODUCTION: Enteral nutrition (EN) is a common nutritional support in intensive care units (ICU). The administration method can be continuous (CEN)or intermittent (IEN), but there are controversies and a lack of evidence on which method is more effective in achieving good nutritional status while minimizing complications. OBJECTIVES: To evaluate the safety (no increase in complications) NEI versus NEC during administration of EN with a gastric feeding tube (GFT) in ICU patients. METHODS: Randomized,open clinical trial.Registered in Clinical Trials. POPULATION: Adults >18 years admitted to ICU,with GFT, indication of EN, signed consent. EXCLUSION: insulin-dependent diabetic. INTERVENTION: Control (CEN): continuous administration via infusion pump; Experimental (IEN): the total amount divided into 4 doses, administered q6 h via infusion pump,for 1 h each dose. OUTCOME VARIABLES: complications (gastrointestinal,respiratory,metabolic), achievement of caloric goal (CG) Others: demographic data, nutritional status, severity (APACHE), EN type, mechanical ventilation (MV), duration of EN, causes of interruption. STATISTICAL ANALYSIS: SPSS. Intention-to-treat analysis. Measures of central tendency and dispersión (standard deviation or interquartile range: IQR), absolute and relative frequencies. Bivariate analysis: Chi2, t-Student, and U-Mann-Whitney. Ethical aspects: CEIm approval. RESULTS: 40 patients (18CEN/22IEN), 70% (28) men, age 62.65 DE:13.27 years (95% CI 58.40-66.90), BMI: 27.93 (IQR:4.6), APACHE II: 18.85 DE: 5.83 (95% CI 16.98-20.72), MV:11.5days (IQR:13).17.5% (7) diabetic. The CEN and IEN groups were homogeneous for all variables except APACHE (CEN 21.22 vs IEN 16.91; p = 0.018). CG was achieved by 82.5% (33) (88.9% CEN vs77.3% IEN, p = 0.33), time to achieve it (36 h CEN vs 34 h IEN; p = 0.28). COMPLICATIONS: vomiting:20% (8) patients (4 per group, p = 0.75). Diarrhea: (16.7%CEN vs 22.7% IEN, p = 0.63). Bronchial aspiration and GRV >500cc 1 case in IEN. Median interruptions (2.5 (IQR: 2) CEN vs 1 (IQR: 2) IEN; p = 0.005). DISCUSSION: The results are similar to other studies. CG was achieved in a high percentage, with no differences between groups. The use of INE shows feweer interruptions, which may lead to better compliance with caloric guidelines without increasing complications, maintaining physiological guidelines. CONCLUSION: IEN in ICU patients shows no differences in terms of complications, compared to CEN, nor less effectiveness in achieving the CG. A larger sample is needed to identify the advantages and complications of each method.