#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#
CS
proLékaře.cz / Journals / Perspectives in Surgery / 2021 - 2

Intermittent feeding in intensive care – the theory and practice

Czech version

Authors: I. Satinský 1,2;  J. Richtarová 1,3
Authors‘ workplace: av ošetřovatelství, Fakulta veřejných politik, Slezská univerzita v Opavě ;  Ústav epidemiologie a ochrany veřejného zdraví, Lékařská fakulta, Ostravská univerzita 3
Published in: Rozhl. Chir., 2021, roč. 100, č. 2, s. 66-73.
Category: Original articles

Overview

Introduction: Nutrition therapy becomes one of the fundamental conditions of a successful outcome in malnourished patients and in critically ill patients. The administration of enteral feeding in critically ill patients is mostly performed by continuous or cyclic feeding. On the contrary, the potential benefits of intermittent feeding include increased muscle protein synthesis. This review outlines the theory of a possible anabolic effect of intermittent feeding. The authors describe their experience with implementation of this method of administration in the intensive care unit including the follow-up of possible complications and adverse effects.

Methods: Six patients with intermittent feeding were followed retrospectively during the study period. In addition to demographic data, potential complications related to intermittent enteral feeding (aspiration pneumonia, increased gastric residual volume, abdominal discomfort, osmotic diarrhoea) were evaluated.

Results: The average time of intermittent feeding was 8 days. The sum of intermittent feeding days was 63. No aspiration followed by pneumonia was detected during this period. The gastric residual volume did not increase, either. Abdominal discomfort and osmotic diarrhoea were not observed in any patient.

Conclusion: Although continuous and cyclic enteral feeding in critically ill patients remains the standard and the most common practice, it is considered as a non-physiological method with possible negative consequences for the patient. On the other hand, intermittent feeding is theoretically associated with respecting of the circadian rhythm and with activation of autophagy. Intermittent feeding increases muscle protein synthesis and supports the release of fatty acids. As shown by our observational study, intermittent administration of enteral nutrition in intensive care can be implemented without any adverse effects; however, it is more time consuming for the nurses.

Keywords:

intermittent feeding – intensive care – enteral nutrition – muscle atrophy – Protein synthesis

Sources
  1. Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48-79. doi: 10.1016/j.clnu.2018.08.037.
  2. Taylor BE, McClave SA, Martindale RG, et al. Guidelines for the provision and assesment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutriton (A.S.P.E.N.). Crit Care Med. 2016;44(2):390-438. doi: 10.1186/s13054-020-2739-4.
  3. Phillips BE, Hill DS, Atherton PJ. Regulation of muscle protein synthesis in humans. Curr Opin Clin Nutr Metab Care 2012;15:58-64. doi: 10.1097/MCO.0b013e32834d19bc.
  4. Atherton PJ, Etheridge T, Watt PW, et al. Muscle full effect after oral protein: time-dependent mechanism concordance and discordance between human muscle protein synthesis and mTORC1 signaling. Am J Clin Nutr. 2010;92:1080−1088. doi: 10.3945/ajcn.2010.29819.
  5. Mitchell WK, Phillips BE, Williams JP, et al. A dose- rather than delivery profile-dependent mechanism regulates the „muscle-full“ effect in response to oral essential amino acid intake in young men. J Nutr. 2015;145(2):207−214. doi: 10.3945/jn.114.199604.
  6. Staples AW, Burd NA, West DW, et al. Carbohydrate does not augment exercise-induced protein accretion versus protein alone. Med Sci Sports Exerc. 2011;43(7):1154−1161. doi: 10.1249/MSS.0b013e31820751cb.
  7. Bodine SC, Latres E, Baumhueter S, et al. Identification of ubiquitin ligases required for skeletal muscle atrophy. Science 2001;23;294(5547):1704−1708. doi: 10.1126/science.1065874.
  8. Puthucheary ZA, Rawal J, McPhail M, et al. Acute skeletal muscle wasting in critical illness. JAMA 2013;310(15):1591−1600. doi: 10.1001/jama.2013.278481.
  9. Suryawan A, O´Connor PM, Bush JA, et al. Differential regulation of protein synthesis by amino acids and insulin in peripheral and visceral tissues of neonatal pigs. Amino Acids 2009;37(1):97−104. doi: 10.1007/s00726-008-0149-z.
  10. Norton LE, Layman DK, Bunpo P, et al. The leucine content of a complete meal directs peak activation but not duration of skeletal muscle protein synthesis and mammalian target of rapamycin signaling in rats. J Nutr. 2009;139(6):1103−1109. doi: 10.3945/jn.108.103853.
  11. Wilson FA, Suryawan A, Orellana RA, et al. Feeding rapidly stimulates protein synthesis in skeletal muscle of neonatal pigs by enhancing translation initiation. J Nutr. 2009;139(10):1873−1880. doi: 10.3945/jn.109.106781.
  12. Kumar V, Selby A, Rankin D, et al. Age-related differences in the dose-response relationship of muscle protein synthesis to resistance exercise in young and old men. J Physiol. 2009;15;587(1):211−217. doi: 10.1113/jphysiol.2008.164483.
  13. Heyland DK, Dhaliwal R, Wang M, et al. The prevalence of iatrogenic underfeeding in the nutritionally ‚at-risk‘ critically ill patient: Results of an international, multicenter, prospective study. Clin Nutr. 2015;34(4):659−666. doi: 10.1016/j.clnu.2014.07.008.
  14. Ichimaru S. Methods of enteral nutrition administration in critically ill patients: continuous, cyclic, intermittent, and bolus feeding. Nutr Clin Pract. 2018;33(6):790−795. doi: 10.1002/ncp.10105.
  15. Brantley SL, Mills ME. Overview of enteral nutrition. In: Mueller CM, ed. The A.S.P.E.N. Nutrition support care curriculum. 2nd ed. Silver Spring. American Society of Parenteral and Enteral Nutrition 2012:170−184.
  16. Serpa LF, Kimura M, Faintuch J, et al. Effects of continuous versus bolus infusion of enteral nutrition in critical patients. Rev Hosp Clin Fac Med Sao Paulo 2003;58(1):9−14. doi: 10.1590/s0041-87812003000100003.
  17. MacLeod JB, Lefton J, Houghton D, et al. Prospective randomized control trial of intermittent versus continuous gastric feeds for critically ill trauma patients. J Trauma 2007;63(1):57−61. doi: 10.1097/01.ta.0000249294.58703.11.
  18. Lee JS, Auyeung TW. A comparison of two feeding methods in the alleviation of diarrhoea in older tube-fed patients: A randomised controlled trial. Age Ageing 2003;32(4):388−393. doi: 10.1093/ageing/32.4.388.
  19. Lee JS, Kwok T, Chui PY, et al. Can conti­nuous pump feeding reduce the incidence of pneumonia in nasogastric tube-fed patients? A randomized controlled trial. Clin Nutr. 2010;29(4):453−458. doi: 10.1016/j.clnu.2009.10.003.
  20. Bankhead R, Boullata J, Brantley S, et al. Enteral nutrition practice recommendations. JPEN 2009;33(2):122−167. doi: 10.1177/0148607108330314.
  21. Bolster DR, Jefferson LS, Kimball SR. Regulation of protein synthesis associated with skeletal muscle hypertrophy by insulin-, amino acid- and exercise-induced signalling. Proc Nutr Soc. 2004;63(2):351−356. doi: 10.1079/PNS2004355.
  22. Katsanos CS, Kobayashi H, Sheffield-Moore M, et al. A high proportion of leucine is required for optimal stimulation of the rate of muscle protein synthesis by essential amino acids in the elderly. Am J Physiol Endocrinol Metab. 2006;291(2):E381−7. doi: 10.1152/ajpendo.00488.2005.
  23. Anthony JC, Yoshizawa F, Anthony TG, et al. Leucine stimulates translation initiation in skeletal muscle of postabsorptive rats via a rapamycin-sensitive pathway. J Nutr. 2000;130(10):2413−2419.  doi: 10.1093/jn/130.10.2413.
  24. Bohé J, Low JF, Wolfe RR, et al. Latency and duration of stimulation of human muscle protein synthesis during continuous infusion of amino acids. J Physiol. 2001;15;532(Pt 2):575−579. doi: 10.1111/j.1469-7793.2001.0575f.x.
  25. Gutierrez-Aguilar R, Woods SC. Nutrition and L and K-enteroendocrine cells. Curr Opin Endocrinol Diabetes Obes. 2011;18(1):35−41. doi: 10.1097/MED.0b013e32834190b5.
  26. Chowdhury AH, Murray K, Hoad CL, et al. Effects of bolus and continuous nasogastric feeding on gastric emptying, small bowel water content, superior mesenteric artery blood flow, and plasma hormone concentrations in healthy adults: A randomized crossover study. Ann Surg. 2016;263(3):450−457. doi: 10.1097/SLA.0000000000001110.
  27. McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) JPEN 2009;33(3):277−316. doi: 10.1177/0148607109335234.
  28. Marik PE. Feeding critically ill patients the right ‚whey‘: Thinking outside of the box. A personal view. Ann Intensive Care 2015;5(1):51. doi: 10.1186/s13613-015-0051-2.
  29. Drucker DJ. Enhancing the action of incretin hormones: A new whey forward? 2006;147(7):3171−3172. doi: 10.1210/en.2006-0494.
  30. Gazzaneo MC, Suryawan A, Orellana RA, et al. Intermittent bolus feeding has a greater stimulatory effect on protein synthesis in skeletal muscle than continuous feeding in neonatal pigs. J Nutr. 2011;141(12):2152−2158. doi: 10.3945/jn.111.147520.
  31. Witard OC, Jackman SR, Breen L, et al. Myofibrillar muscle protein synthesis rates subsequent to a meal in response to increasing doses of whey protein at rest and after resistance exercise. Am J Clin Nutr. 2014;99(1):86−95. doi: 10.3945/ajcn.112.055517.
  32. Yang Y, Breen L, Burd NA, et al. Resistance exercise enhances myofibrillar protein synthesis with graded intakes of whey protein in older men. Br J Nutr. 2012;108(10):1780−1788. doi: 10.1017/S0007114511007422.
  33. Hermans G, Casaer MP, Clerckx B, et al. Effect of tolerating macronutrient deficit on the development of intensive-care unit acquired weakness: a subanalysis of the EPaNIC trial. Lancet Respir Med. 2013;1(8):621−629. doi: 10.1016/S2213-2600(13)70183-8.
  34. Gunst J. Recovery from critical illness-induced organ failure: the role of auto­phagy. 2017;21(1):209. doi: 10.1186/s13054-017-1786-y.
  35. Patel JJ, Rosenthal MD, Heyland DK, et al. Intermittent versus continuous feeding in critically ill adults. Curr Opin Clin Nutr Metab Care 2018;21(2):116−120. doi: 10.1097/MCO.0000000000000447.
  36. Wene JD, Connor WE, DenBesten L. The development of essential fatty acid deficiency in healthy men fed fat-free diets intravenously and orally. J Clin Invest. 1975;56(1):127−134. doi: 10.1172/JCI108061.
  37. Goossens C, Vander Perre S, Van den Berghe G, et al. Proliferation and differentiation of adipose tissue in prolonged lean and obese critically ill patients. Intensive Cre Med. 2017;5(1):16. doi: 10.1186/s40635-017-0128-3.
  38. Bonten MJ, Gaillard CA, van der Hulst R, et al. Intermittent enteral feeding: the influence on respiratory and digestive tract colonization in mechanically ventilated intensive-care-unit patients. Am J Respir Crit Care Med. 1996;154(2 Pt 1):394−399. doi: 10.1164/ajrccm.154.2.8756812.
  39. Evans DC, Forbes R, Jones C, et al. Continuous versus bolus tube feeds: Does the modality affect glycemic variability, tube feeding volume, caloric intake, or insulin utilization? Int J Crit Illn Inj Sci. 2016;6(1):9−15. doi: 10.4103/2229-5151.177357.
  40. Dyck LV, Casaer MP. Intermittent or continuous feeding: any difference during the first week? Curr Opin Crit Care 2019;25(4):356−362. doi: 10.1097/MCC.0000000000000617.
  41. Bear DE, Hart N, Puthucheary Z. Continuous or intermittent feeding: pros and cons. Curr Opin Crit Care 2018;24(4):256−261. doi: 10.1097/MCC.0000000000000513.
Labels
Surgery Orthopaedics Trauma surgery
Perioperative nutrition in the light of guidelines (and in the shadow of practice)
New options for surgeons to improve malnutrition in the outpatient setting
Výživa v chirurgii: jak dostat koně do Tróje?
Rectal cancer – current treatment strategy and the tumor regression grade evaluation after neoadjuvant therapy in patients who underwent surgery at the I. Department of Surgery, General University Hospital in Prague between 2012 and 2016
Nutrition in open abdomen
Multidisciplinary surgical approach to renal cancer with vena cava invasion and pulmonary embolism
Perforation of descending colon diverticulum by swallowed rabbit bone – a case report
Article was published in

Perspectives in Surgery

Issue 2
2021 Issue 2
Most read in this issue
Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#