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Nutrition in acute and chronic diseases

Clinical efficacy of enteral nutrition feeding modalities in critically ill patients: a systematic review and meta-analysis of randomized controlled trials

European Journal of Clinical Nutrition volume 77, pages 1026–1033 (2023)Cite this article

Subjects

Abstract

Background

In intensive care units (ICUs), both continuous and intermittent feeding are commonly used for early enteral nutrition (EN). However, whether continuous feeding is a preferable feeding modality compared to intermittent feeding remains unclear. Therefore, this meta-analysis assessed the clinical efficacy of both EN feeding modalities in critically ill patients.

Methods

The PubMed, Embase, and Cochrane Library databases were searched from their inception dates to December 29, 2022. The search did not involve language restrictions (PROSPERO CRD42022371756). Randomized controlled trials (RCTs) comparing the clinical efficacy and safety of continuous feeding and intermittent feeding in critically ill patients in ICUs were included.

Results

We included 13 RCTs involving 785 patients. Compared with intermittent feeding, continuous feeding was associated with a lower mortality rate (relative risk [RR], 0.68; 95% confidence interval [CI], 0.47, 0.98; p = 0.04) but a higher risk of constipation (RR, 1.57; 95% CI, 1.02, 2.43; p = 0.04). Trial sequential analysis (TSA) for mortality rate presented a cumulative Z-curve crossing the traditional boundary, but the curve did not cross the TSA boundary for benefit. No significant differences were found in the aspiration/pneumonia rate (RR, 1.19; 95% CI, 0.51, 2.75; p = 0.69), diarrhea rate (RR, 0.82; 95% CI, 0.58, 1.16; p = 0.26), or increased gastric residual volumes (RR, 1.05; 95% CI, 0.58, 1.90; p = 0.86) between the groups.

Conclusion

Despite the low certainty of evidence, compared with intermittent feeding, continuous feeding may reduce the mortality rate in critically ill patients in ICU. Additional studies are needed to provide more evidence and validate the findings.

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Fig. 1
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Fig. 5: Results of forest plot analysis of outcomes between continuous feeding and intermittent feeding.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author information

Author notes

  1. These authors contributed equally: Jheng-Yan Wu, Mei-Yuan Liu.

Authors and Affiliations

  1. Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan

    Jheng-Yan Wu, Mei-Yuan Liu & Chia-Yin Kuo

  2. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Jheng-Yan Wu

  3. Department of Nutrition and Health Sciences, Chang Jung Christian University, Tainan, Taiwan

    Mei-Yuan Liu

  4. Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan

    Mei-Yuan Liu

  5. Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan

    Ting-Hui Liu

  6. Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan

    Kuo-Chuan Hung

  7. School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan

    Kuo-Chuan Hung & Chih-Cheng Lai

  8. Center for Integrative Medicine, Chi Mei Medical Center, Tainan, Taiwan

    Ya-Wen Tsai

  9. Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan

    Chih-Cheng Lai

  10. Department of General Medicine, Chi Mei Medical Center, Tainan, Taiwan

    Wan-Hsuan Hsu

  11. Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan

    Min-Hsiang Chuang & Po-Yu Huang

  12. Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan

    Hung-Tze Tay

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Contributions

JYW, MYL, THL, CYK, KCH, YWT, WHH, MHC, PYH, CCL, and HTT contributed to this study, including the conception and design of the research. JYW, MYL, THL, CYK, KCH, and PYH performed data extraction, analyses, and interpretation of data, and CCL was a third reviewer to resolve any disagreements. JYW and THL assisted in statistics, and JYW and PYH ensured the certainty of evidence in accordance with the GRADE statement. JYW, MYL, THL, CYK, KCH, YWT, WHH, MHC, and PYH drafted the manuscript. This manuscript was revised by CCL and HTT. All authors gave final approval and agreed to all aspects of the work, ensuring integrity and accuracy.

Corresponding authors

Correspondence to Po-Yu Huang or Hung-Tze Tay.

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Wu, JY., Liu, MY., Liu, TH. et al. Clinical efficacy of enteral nutrition feeding modalities in critically ill patients: a systematic review and meta-analysis of randomized controlled trials. Eur J Clin Nutr 77, 1026–1033 (2023). https://doi.org/10.1038/s41430-023-01313-8

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