CHEST Guidelines-Intermittent-Enteral-Nutrition-as-a-Sole-Intervent (1)

Intermittent-Enteral-Nutrition-as-a-Sole-Intervent (1)

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The study by McNelly et al., published in CHEST, evaluates the effects of intermittent versus continuous enteral nutrition (EN) on muscle wasting in critically ill adults. This phase II randomized controlled trial involved mechanically ventilated patients with multiorgan failure expected to remain in the ICU for at least seven days. The trial aimed to discern if intermittent feeding could mitigate muscle loss compared to the traditional continuous feeding method, given the theory that continuous EN might raise amino acid concentrations and suppress muscle protein synthesis.<br /><br />A total of 127 participants were enrolled, with 62 receiving intermittent EN (six feeds daily over 3-5 minutes each) and 59 receiving continuous EN. The primary outcome was the difference in muscle mass loss, measured by rectus femoris cross-sectional area over ten days, using ultrasound.<br /><br />Results showed no significant difference in muscle wasting between the two groups. Only 49% of participants were available for assessment by day 10, with adjustments for confounding factors showing no variation in muscle preservation between feeding regimens. Importantly, while nutrition targets were more successfully met with intermittent feeding, plasma amino acid levels did not differ significantly between groups, and no improvements were noted in physical function or quality of life.<br /><br />Despite achieving nutritional targets more frequently, intermittent feeding did not demonstrate a significant impact on muscle wasting. The study suggests that, while intermittent feeding is safe, it does not provide clear benefits over continuous feeding concerning muscle preservation. The trial underscores the complexity of nutrition and metabolism in the critically ill and highlights the need for future research to explore the mechanistic aspects of nutritional interventions and their impact on recovery.

Keywords

intermittent feeding

continuous feeding

enteral nutrition

muscle wasting

critically ill

randomized controlled trial

ICU

amino acids

nutrition targets

mechanical ventilation