CHEST Guidelines-Intermittent-Enteral-Nutrition-as-a-Sole-Intervent

Intermittent-Enteral-Nutrition-as-a-Sole-Intervent

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The document presents the findings of a study by McNelly et al., as discussed in an editorial by Emma J. Ridley and Sandra L. Peake, regarding the impact of intermittent enteral nutrition (EN) versus continuous EN on muscle wasting in critically ill patients. Conducted in eight mixed UK ICUs, this phase II randomized controlled trial involved 127 critically ill, mechanically ventilated adults predicted to stay in ICU for over seven days. The hypothesis was intermittent feeding might reduce muscle wasting due to fluctuations in amino acid concentrations promoting an anabolic process.<br /><br />The study measured the 10-day change in rectus femoris muscle cross-sectional area (RFCSA) using ultrasound, with 63 patients (49%) available for assessment at day 10. Results showed no significant difference in muscle wasting between the two groups, with or without adjustment for confounders. The intermittent group had a higher likelihood of achieving nutrition targets, but without affecting plasma amino acid concentrations or physical and quality of life outcomes. Glycemic variability was more pronounced in the intermittent group, though no major gastrointestinal side effects were reported.<br /><br />The editorial acknowledges the trial's rigor and novelty in choosing an outcome more relevant to nutritional interventions than traditional measures like mortality. Despite the lack of significant findings, the study is deemed valuable for highlighting the complex interplay between nutrition and metabolism in critical care. The editorial suggests while intermittent feeding does not significantly impact muscle wasting on its own, it may safely meet nutritional targets and might benefit patients transitioning from EN to oral diets. Future research should continue exploring mechanisms by which nutrition can aid recovery in critically ill patients beyond merely focusing on timing and dosage.

Keywords

intermittent enteral nutrition

continuous enteral nutrition

muscle wasting

critically ill patients

randomized controlled trial

rectus femoris muscle

nutrition targets

glycemic variability

mechanically ventilated

critical care metabolism