Intermittent or continuous feeding: any difference during the first week?

  title={Intermittent or continuous feeding: any difference during the first week?},
  author={Lisa Van Dyck and Michael P. Casaer},
  journal={Current Opinion in Critical Care},
PURPOSE OF REVIEW To balance theoretical pros and cons of intermittent feeding, in light of the current nutritional management early during critical illness. RECENT FINDINGS Less aggressive nutrient administration is clinically superior in acute critical illness. This counterintuitive clinical finding may be explained by nutrient restriction activating autophagy, a process that clears intracellular damage. Intermittent feeding holds numerous theoretical benefits, such as activation of… 
Are periods of feeding and fasting protective during critical illness?
These findings open perspectives for the design and clinical validation of intermittent feeding regimens for critically ill patients, and the optimal mode and duration of the fasting interval, if any, remain unclear.
Role of ketones, ketogenic diets and intermittent fasting in ICU
Clinical evidence for beneficial effects of ketones, ketogenic diets and intermittent fasting in critical illness is summarized, potential mechanisms behind such effects are reviewed, and potential protective mechanisms are reviewed.
Intermittent feeding and circadian rhythm in critical illness
Aligning timing of nutritional intake, physical activity, and/or medication with circadian rhythms are potential strategies to reset peripheral circadian rhythms and may enhance ICU recovery but is not proven beneficial yet.
Reconsidering Nutritional Support in Critically Ill Patients.
Non-continuous modes of feeding in the modern ICU era may have advantages related to fewer feeding interruptions, ICU mobilization, optimizing protein synthesis and autophagy, as well as restoring gastrointestinal physiology and the circadian rhythm.
Continuous versus Intermittent Enteral Tube Feeding for Critically Ill Patients: A Prospective, Randomized Controlled Trial
For patients undergoing mechanical ventilation, continuous enteral feeding significantly improved the achievement of target nutrition requirements.
A broader perspective of nutritional therapy for the critically ill.
  • A. Deane, M. Casaer
  • Medicine
    Current opinion in clinical nutrition and metabolic care
  • 2020
The take home message from this systematic review is that, at least for now, accurate measurement of energy expenditure with indirect calorimetry does not need to be implemented for every critically ill patient, and the authors do observe signals of benefit when attempting to measure energy expenditure and advocate for ongoing research using indirect calerimetry.
Nutrition management in acute pancreatitis: Clinical practice consideration.
The current article aims to review the latest evidence and suggest practical nutrition interventions in patients with AP, including nutrition requirements, routes of nutrition treatment, types of formula, and the role of nutritional supplements, such as glutamine, probiotics, omega-3 fatty acids, and antioxidants.
Rheostatic Balance of Circadian Rhythm and Autophagy in Metabolism and Disease
The role of rhythmic autophagy in nutrient and energy metabolism and its significance in physiology and metabolic disease is presented and the molecules influencing both Autophagy and circadian rhythm are introduced.


Enteral nutrition in critical patients; should the administration be continuous or intermittent?
The administration modalities of continuous or intermittent enteral nutrition are similar in which regards the comparison of the variables included in this study, with no statistically significant difference in the variables vomiting, abdominal distension or diarrhea.
Intermittent versus continuous feeding in critically ill adults
Studies in healthy humans suggest that intermittent nutrient administration, as opposed to continuous, improves whole body protein synthesis, and until further studies are conducted in critically ill patients, a recommendation for or against intermittent nutrition delivery cannot be made.
Mechanisms underlying feed intolerance in the critically ill: implications for treatment.
Current understanding of the factors responsible for, and mechanisms underlying feed intolerance in critical illness, together with the evidence for current practices are summarized, and areas requiring further research are highlighted.
Effects of continuous versus bolus infusion of enteral nutrition in critical patients.
The two groups were similar in this regard, without statistical differences, probably because of meticulous technique, careful monitoring, strict patient matching, and conservative amounts of diet employed in both situations.
Role of disease and macronutrient dose in the randomized controlled EPaNIC trial: a post hoc analysis.
Early combined parenteral/enteral nutrition delayed recovery irrespective of severity of critical illness and no dose or type of macronutrient was found to be associated with improved outcome.
Short-term amino acid infusion improves protein balance in critically ill patients
Extra parenteral amino acids infused over a 3-hour period improved whole-body protein balance and did not increase amino acid oxidation rates in critically ill patients during the early phase (first week) of critical illness.
Comparison of Intermittent and Bolus Enteral Feeding Methods on Enteral Feeding Intolerance of Patients with Sepsis: A Triple-blind Controlled Trial in Intensive Care Units
Bolus method can still be used as a standard method to decrease the risk of enteral feeding intolerance if it is used properly, and no statistically significant difference was found between all variables in the three studied groups during the 3 days.
Impact of early parenteral nutrition on metabolism and kidney injury.
Early parenteral nutrition does not seem to impact AKI incidence, although it may delay recovery in patients with stage 2 AKI, and substantial catabolism of the extra amino acids, which leads to higher levels of plasma urea, might explain the prolonged duration of renal replacement therapy observed with early parenTERal nutrition.
Prospective randomized control trial of intermittent versus continuous gastric feeds for critically ill trauma patients.
Patients from both the intermittent and continuous feeding regimens reached the goal during the study period of 7 days but the intermittent regimen patients reached goal enteral calories earlier than the continuous regimen patients, which is equivalent to a standard drip-feeding regimen.