Effects of intermittent feeding versus continuous feeding on tolerance, nutritional indexes, and prognosis in critically ill patients undergoing mechanical ventilation

doi:10.3969/j.issn.1004-583X.2023.10.008

Abstract

Abstract: Objective To compare the effects of intermittent feeding versus continuous feeding on the tolerance, nutritional indexes and prognosis of critically ill patients undergoing mechanical ventilation. Methods A total of 100 critically ill patients receiving mechanical ventilation in the Handan Central Hospital from June 2021 to June 2022 were recruited. They were randomly divided into continuous feeding group (50 cases) and intermittent feeding group (50 cases). The compliance rate of nutrition calories, feeding tolerance, mechanical ventilation time and nutritional indexes were compared between the two groups. Nutritional indexes included prealbumin (PA), albumin (ALB), total protein (TP), and hemoglobin (Hb). Results There was no significant difference in the compliance rate of nutrition calories from the 1st to 6th day of feeding (P>0.05). On the 7th day of feeding, the compliance rate of nutrition calories was significantly higher in patients of intermittent feeding group than that of continuous feeding group (P<0.05). There were no significant differences in feeding tolerance and mechanical ventilation time between the two groups (P>0.05). There were no significant difference in ALB, PA and Hb levels on the 1st and 7th day of feeding between the two groups (P>0.05). After enteral nutrition support, ALB and Hb on the 7th day of feeding were significantly enhanced in both groups (P<0.05). Conclusion Early intermittent feeding provides a comparable effect with continuous feeding on critically ill patients with mechanical ventilation. Improving feeding tolerance is the key to improve the feeding effect.

Key words: respiration, artificial, enteral nutrition, nutritional support, tolerance

CLC Number:

R605.973

Wei Peixuan, Lan Xiaojing, Wu Tingting, Shi Junfeng, Xue Yanying, Wang Jingmei. Effects of intermittent feeding versus continuous feeding on tolerance, nutritional indexes, and prognosis in critically ill patients undergoing mechanical ventilation[J]. Clinical Focus, 2023, 38(10): 907-911.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.10.008

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I10/907

Figures/Tables 6

Tab. 1 Enteral nutrition tolerance scale (score) [9]

评价内容	计分标准
评价内容	0	1	2	5
腹胀/腹痛	无	轻度腹胀/无腹痛	明显腹胀或腹痛自行缓解或腹内压15~20 mmHg	严重腹胀或腹痛不能自行缓解或腹内压>20 mmHg
恶心/呕吐	无或持续胃肠减压无症状	恶心但无呕吐	恶心呕吐,不需胃肠减压或250 ml<胃残余量(gastric residual volume,GRV)<500 ml	呕吐,且需胃肠减压或GRV>500 ml
腹泻	无	稀便3~5次/d,且量<500 ml	稀便>5次/d,且量500~1500 ml	稀便>5次/d且量>1500 ml

Tab. 2 Comparison of baseline data between groups ($\bar{x}$±s)

组别	例数 (男/女)	年龄 (岁)	BMI (kg/m²)	疾病类型(例)			APACHEII 评分(分)	mNUTRIC (分)	AGI分级(例)
组别	例数 (男/女)	年龄 (岁)	BMI (kg/m²)	神经系统疾病	多发外伤	其他	APACHEII 评分(分)	mNUTRIC (分)	Ⅰ	Ⅱ	Ⅲ
间断组	50(31/19)	62.780±11.132	24.000±3.674	28	8	14	26.40±2.821	8.18±1.792	19	21	2
持续组	50(29/21)	61.660±12.077	24.520±4.159	23	10	17	26.28±2.603	8.40±1.784	25	23	2
统计值	χ²=0.167	$t$ =0.482	$t$ =0.653	χ²=1.003			$t$ =0.221	$t$ =0.615	$Z$ =1.139
$P$ 值	0.683	0.631	0.515	0.606			0.826	0.540	0.164

Tab. 2 Comparison of baseline data between groups ($\bar{x}$±s)

组别	例数 (男/女)	年龄 (岁)	BMI (kg/m²)	疾病类型(例)			APACHEII 评分(分)	mNUTRIC (分)	AGI分级(例)
组别	例数 (男/女)	年龄 (岁)	BMI (kg/m²)	神经系统疾病	多发外伤	其他	APACHEII 评分(分)	mNUTRIC (分)	Ⅰ	Ⅱ	Ⅲ
间断组	50(31/19)	62.780±11.132	24.000±3.674	28	8	14	26.40±2.821	8.18±1.792	19	21	2
持续组	50(29/21)	61.660±12.077	24.520±4.159	23	10	17	26.28±2.603	8.40±1.784	25	23	2
统计值	χ²=0.167	$t$ =0.482	$t$ =0.653	χ²=1.003			$t$ =0.221	$t$ =0.615	$Z$ =1.139
$P$ 值	0.683	0.631	0.515	0.606			0.826	0.540	0.164

Tab. 3 Comparison of enteral nutrition tolerance between groups (n)

组别	例数	耐受等级	第1天	第2天	第3天	第4天	第5天	第6天	第7天
间断组	50	良	44	34	30	22	35	41	42
		中	4	12	12	18	11	6	5
		差	2	4	8	10	4	3	3
持续组	50	良	43	36	32	30	40	35	42
		中	5	11	15	12	9	10	6
		差	2	3	3	8	2	5	2
$Z$ 值			-0.283	-0.464	-0.737	-1.425	-1.019	-1.386	-0.043
$P$ 值			0.777	0.643	0.461	0.154	0.308	0.166	0.965

Tab. 3 Comparison of enteral nutrition tolerance between groups (n)

组别	例数	耐受等级	第1天	第2天	第3天	第4天	第5天	第6天	第7天
间断组	50	良	44	34	30	22	35	41	42
		中	4	12	12	18	11	6	5
		差	2	4	8	10	4	3	3
持续组	50	良	43	36	32	30	40	35	42
		中	5	11	15	12	9	10	6
		差	2	3	3	8	2	5	2
$Z$ 值			-0.283	-0.464	-0.737	-1.425	-1.019	-1.386	-0.043
$P$ 值			0.777	0.643	0.461	0.154	0.308	0.166	0.965

Tab. 4 Comparison of daily compliance rate of nutrition calories between groups (n)

组别	例数	第1天	第2天	第3天	第4天	第5天	第6天	第7天
间断组	50	43	43	25	18	15	20	23
持续组	50	40	35	20	15	10	12	15
χ²值		0.638	3.730	1.010	0.407	1.333	2.941	5.319
$P$ 值		0.424	0.053	0.053	0.523	0.248	0.086	0.021

Tab. 4 Comparison of daily compliance rate of nutrition calories between groups (n)

组别	例数	第1天	第2天	第3天	第4天	第5天	第6天	第7天
间断组	50	43	43	25	18	15	20	23
持续组	50	40	35	20	15	10	12	15
χ²值		0.638	3.730	1.010	0.407	1.333	2.941	5.319
$P$ 值		0.424	0.053	0.053	0.523	0.248	0.086	0.021

Tab. 5 Comparison of nutritional indicators on the 1st and 7th day of feeding between groups ($\bar{x}$±s, g/L)

组别	例数	ALB		PA		Hb
组别	例数	第1天	第7天	第1天	第7天	第1天	第7天
间断组	50	30.560±3.580	32.040±2.610^*	0.191±0.050	0.202±0.080	118.800±14.360	123.860±10.300^*
持续组	50	30.740±3.430	32.600±2.220^*	0.195±0.060	0.203±0.023	116.060±10.840	125.220±6.210^*
$t$ 值		0.256	1.153	0.307	0.108	1.076	0.799
$P$ 值		0.798	0.252	0.759	0.914	0.285	0.425

Tab. 5 Comparison of nutritional indicators on the 1st and 7th day of feeding between groups ($\bar{x}$±s, g/L)

组别	例数	ALB		PA		Hb
组别	例数	第1天	第7天	第1天	第7天	第1天	第7天
间断组	50	30.560±3.580	32.040±2.610^*	0.191±0.050	0.202±0.080	118.800±14.360	123.860±10.300^*
持续组	50	30.740±3.430	32.600±2.220^*	0.195±0.060	0.203±0.023	116.060±10.840	125.220±6.210^*
$t$ 值		0.256	1.153	0.307	0.108	1.076	0.799
$P$ 值		0.798	0.252	0.759	0.914	0.285	0.425

Tab. 6 Comparison of mechanical ventilation time between groups ($\bar{x}$±s)

组别	例数	机械通气时间(d)
间断组	50	11.14±2.33
持续组	50	10.84±1.82
$t$ 值		0.717
$P$ 值		0.475

Tab. 6 Comparison of mechanical ventilation time between groups ($\bar{x}$±s)

组别	例数	机械通气时间(d)
间断组	50	11.14±2.33
持续组	50	10.84±1.82
$t$ 值		0.717
$P$ 值		0.475

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