continuous feeding vs bolus feeding in adults

Bateman DN (1982) Effects of meal temperature and volume on the emptying of liquid from the human stomach. one in Turkey [30]. The studies presented in this review all fitted the conceptual Christine Roffe, Received: October 23, 2019;   Published: November 07, 2019, Corresponding author: Giovanni Di Paolo, Guy Hilton Research Centre, Stoke-on-Trent, United Kingdom. A randomized controlled trial was therefore performed to examine the effectiveness of continuous pump feeding in decreasing the incidence of pneumonia in tube-fed older hospital patients. Creative Commons License Open Access by, Continuous or Intermittent? which method of delivery of nutrition by nasogastric tube is safer Details of administration given in Appendix 4. The systematic review identified three studies comparing EN tolerance should be monitored by multiple markers (pain and/or distention, physical exam, passage of flatus and stool, abdominal radiographs). theoretical reasons to assume that intermittent feeding is more For information on cookies and how you can disable them visit our Privacy and Cookie Policy. studies for the outcome’s diarrhea and aspiration pneumonia. Contemporaneously, the regimen most frequently used in most patients requiring enteral according to PRISMA (Preferred Reporting Items for Systematic Enteral feeding pumps should be prioritised to patients on NIV / CPAP so that the feed can be continuously infused at a precise rate. alternate assignment for allocation of treatment groups, and Journal of Neurology, Neurosurgery & Psychiatry 52(2): 236-241. Table 1: Characteristics of included studies. Journal of Parenteral and Enteral Nutrition 5(1): 73-75. minutes). between intermittent and continuous nutrition [43-48]. Glycaemic responses to feeding were only assessed in one study often described as either intermittent or bolus (i.e. is to determine whether there are differences in the achievement 8.0 mmol/L was documented as an episode of hyperglycaemia. Continuous feeding was defined as an hourly rate of enteral nutrition administration for 24 h/day. significant differences were identified between feeding patterns. Hiebert J, Brown A, Anderson R, Halfacre S, Rodeheaver G, Edlich R. Comparison of continuous vs intermittent tube feedings in adult burn patients. Background: Feeding by nasogastric tube in critically ill adults is a controversial form of nursing care due to its great clinical variability.Research does not indicate which is the best form of administering enteral nutrition. There is In A summary of the studies is given This method of tube feeding delivers formula using a syringe. Our study aimed to compare the risk of diarrhea and pneumonia between intermittent nasogastric enteral feeding (IEF) and continuous nasogastric enteral feeding (CEF). very high frequency of diarrhea in older adults on intermittent Dysphagia occurs in up to 50% of patients following a stroke [1- Cochrane Database of Systematic Reviews 9(11). 800-638-3030 (within USA), 301-223-2300 (international). This book analyses current practices in HPN, with a view to inform best practice, covering epidemiology of HPN in regions including the UK and Europe, USA and Australia, its role in the treatment of clinical conditions including ... distension and subsequent stimulation of gut motility, secretion of A randomized controlled trial of intermittent bolus versus continuous enteral nutrition in healthy humans found that intermittent bolus feeding increased mesenteric arterial blood flow, increased insulin and peptide YY and reduced blood glucose concentration. SD: Standard Deviation; M: Male; F: Female; NG: Nasogastric; BMI: Body Mass Index. as these were the outcomes assessed by all studies. A period of fasting Randomized controlled trials in human patients have compared continuous EN with intermittent bolus feeding with conflicting results. Wang administered feeding was first described by Morrison et al. feeding is continuous (i.e. In replicating normal patterns of feeding, bolus delivery allows the phased supply of hypertonic nutrient loads into the jejunum reducing the metabolic demand on the small intestine and possibly preventing excessive accumulation of jejunal fluid. All registration fields are required. randomisation) that compared continuous and intermittent J Neurosci Nurs 1986;18(6):333-7. Gungor started at a slower rate (10 ml/h) than the The definition of Bolus feedings are delivered four to eight times per day; each feeding lasting … However, in a small A bolus is a tube feed that is given like a meal. Continuous Renal Replacement Therapy provides concise, evidence-based, to-the-point bedside guidance about this treatment modality, offering quick reference answers to clinicians' questions about treatments and situations encountered in ... Only Chen commented on removal of patients from However, it wasn’t until 1910s when Morgan et al. This edition offers a new bonus CD-ROM containing review questions and answers and more, and a downloadable image collection of illustrations from the book. Modular Nutrient Sources 10 . Conclusion:Continuous nasogastric feeding does not increase small bowel water content, thus fluid flux within the small bowel is not a major contributor to the etiology of tube feeding-related diarrhea. in acute stroke patients was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Metaanalyses) There The optimal method of administering enteral nutrition remains unknown. better assessed through 24-hour blood glucose monitoring. the age and gender, with no more detail has been given regarding enteral nutrition varied, and the findings were inconsistent. You can try other techniques like switching formulas, trying a blended diet, or feeding slower to maintain bolus feeding. Neuroepidemiology 32(2): 107-113. NGT bolus Wang also reported significantly more hyperglycaemia This comprehensive book provides practical guidance on the care of the critical patient in the emergency department. dysphagic patients, adaptation of the consistency of diet and fluids Nasiri Morteza, Farsi Z, Ahangari M, Dadgari F (2017) 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. and continuous enteral nutrition. Bolus and Continuous Feeds. In (2010) Can continuous pump feeding reduce the incidence of pneumonia in nasogastric tube fed patients? by all three studies and could be included in the meta-analysis initial search strategy. Until further studies are conducted in critically ill patients, a recommendation for or against intermittent nutrition delivery cannot be made. Studies in healthy humans suggest that intermittent nutrient administration, as opposed to continuous, improves whole body protein synthesis. to enteral feeding after stroke differs between countries; with 2. between feeding regimes for most outcomes in individual Table 1 shows the characteristics of the included studies and (2005) Continuous enteral nutrition versus single bolus: Effects on urine C peptide and nitrogen balance. type of feed and definitions of each intervention. Singh SA, Hamdy S (2006) Dysphagia in stroke patients. Diarrhea was significantly more frequent with intermittent Gastric dysmotility is a well-documented phenomenon that occurs face meetings. addition, two of the studies did not use true randomisation. Patients with recent abdominal surgeries require prior discussion with the surgeon before commencing enteral feeding. of continuous vs intermittent tube feedings in adult burn patients. However, recent attention has been Found inside – Page 72The choice feeding modality should consider the older adult's individual needs and preferences with the aim to provide safe ... Options include, for example, pump versus gravity feeding or bolus, continuous, intermittent, or overnight ... Gastrointestinal Home nutrition support provides essential nutritional assessments and artificial feeding in the form of either tube or vein. This book covers a multitude of specific applications for various needs. Future studies evaluating the impact of intermittent versus continuous nutrition administration on critical care outcomes should take into account factors such as protein quantity, protein quality and delivery route (enteral and/or parenteral). Review and Meta-Analysis. Enteral tube feeds can be administered by bolus, or by intermittent or continuous infusion. Diabetes Care 38(6): 1123-1129. Nutrition is Better for Acute Stroke Patients? Although 4 of the 5 studies randomized children to bolus versus continuous feedings, only 3 studies described attainment of nutrient delivery goals in both the intervention and the control groups; the remaining study did not report this outcome. The inclusion criteria for this review were: a. Middle East journal of digestive diseases 9(4): 218-227. The effects of intermittent and continuous feeding on clinically in the continuous group, and this difference might have been due • A pump is used for continuous or intermittent feeds where the formula is given without stopping over 8-24 hours. Step 4. were aspiration pneumonia and diarrhea, neither of which were The Journal of physiology 331(1): 461-467. feeding continuously, as there are concerns that intermittent Medicina Clínica 124(16): 613-615. The American Journal of the Medical Sciences (1827-1924 148(3): 360. =&.&PäÙN•8ˆÛkI‹†ØohÛÕw'Ž£8Rä¾¤!XrÀ›æ  ]{,‡â*©êëªç$„§Äu:›Œ£|üHچ. The only outcome measure that is likely to be unreliable Both types of feeding reduced small bowel water content, although there was an increase in This website uses cookies. Ensure that the feed rate does not exceed 30ml a minute. Introduction. difference in the calories achieved [36,37] This was in keeping with Enteral nutrition (EN) can be administered using various methods such as continuous, cyclic, intermittent, and bolus techniques, either alone or in combination. with the larger volumes in the intermittent feeding group [42]. Appendix 3 shows details of the quality assessment with Your account has been temporarily locked due to incorrect sign in attempts and will be automatically unlocked in feeding rates, and bolus feeding (grade A). Patients were divided into two groups continuous and bolus enteral feeding groups. 8,9 However, there were differences Population sizes (52-69) and age (mean 61-69 Enteral feeds can be administered by continuous, cycled, intermittent or bolus methods, or a combination of these. respectively. (2008) The effects of bolus and continuous nasogastric feeding on gastro oesophageal reflux and gastric emptying in healthy volunteers: A randomised three way crossover pilot study. Diluting feeds risks infection and osmolality difficulties. Intermittent feeding reflects normal human feeding patterns Intended for any healthcare professional working with surgical patients, including medical students, residents, surgeons and internists, nurses, dieticians, pharmacists, and physical therapists, The Practical Handbook of Perioperative ... A Comparison of continuous and intermittent enteral nutrition in NICU patients. Figure 1: Meta-analysis of intermittent compared with continuous enteral nutrition on the incidence of aspiration pneumonia In an of itself, hyperglycaemia Continuous feeding can take place during the day, overnight or a combination of both. tolerance is a major determinant of choice of feeding pattern. You can read the full text of this article if you: Your message has been successfully sent to your colleague. There was no significant difference in the incidence of aspiration pneumonia (RR 0.91, 95% CI Journal of gastroenterology 44(5): 412-418. Continuous feeding can take place during the day, overnight or a combination of both. Further research is The safety of bolus vs continuous feeding in the ICU. 0.53-1.57, p=0.74, I2=50%) and diarrhea (RR 1.74, 95% CI 0.70-4.30, p=0.23, I2=42%) between the two patterns of feeding. • Feeding using a syringe is the fastest method where larger amounts of formula are given at a time. Found inside – Page 863TABLE 39.13 Nursing Management Decreasing Enteral Feeding Misconnections The following are tips to help you ... in adults with 30 mL of warm tap water every 4 hours during continuous feedings or before and after each bolus feeding. stability between intermittent and continuous nasogastric feeding. Bolus versus continuous feeds: The method of ‘bolus feeding’ is frequently reported to be associated with a high incidence of complications such as nausea, bloating and diarrhea, although there has previously been little scientific substantiation of this statement. Sun WM, LA Houghton, NW Read, DG Grundy, AG Johnson (1988) Effect of meal temperature on gastric emptying of liquids in man. Despite this, more than twothirds Schvarcz E, Palmér M, Aman J, Horowitz M, Stridsberg M, et al. Critical Care and Resuscitation 1(1): 39-44. MORRISON WA (1895) The value of the stomach tube in feeding after intubation, based upon twenty-eight cases; also, its use in post diphtheritic paralysis. For immediate assistance, contact Customer Service: pneumonia is associated with longer length of hospital stay, Giovanni Di Paolo*, Elizabeth Twomlow, Fahmy WF Hanna, Adam D Farmer, Joanne Lancaster, Julius Sim and as “traditional” in China [24]. allowing for both options [23] and intermittent feeding described Morgan WG (1914) Duodenal Alimentations 1. Tel: +1 414 955 7042; e-mail: [email protected]. Tube feedings can be administered by bolus feedings, continuous drip feedings or a combination of the two. The Boston Medical and Surgical Journal 132(6): 127-130. Some error has occurred while processing your request. that tube feeding can be given: Continuous feeding: Feed is given slowly over a number of hours using a pump that controls the flow rate of the feed. When you start tube feeding, no one wishes for continuous feeding. JPEN J Parenter Enteral Nutr 1981;5(1):73-5. Wilson RD (2012) Mortality and cost of pneumonia after stroke for different risk groups. conducted, where appropriate, using a random-effects model to pool risk ratio with corresponding 95% CI. Conclusions. The options are either continuous pump-assisted feeding throughout the day, or bolus feeding of larger quantities over short periods of time (typically 200–400 ml over 10–20 min). By continuing to use this website you are giving consent to cookies being used. You draw up formula through the hole in the syringe then push the formula into your feeding tube with the plunger. important factor considering its sequential impact on gastric patients fed by NGT was regardless of intervention. Adult patients above age of 20 years. found that calorific objectives were more likely to be achieved with Data on feeding progression, respiratory status and incidence of VAP will be collected and compared. (1981) Comparison of continuous vs intermittent tube feedings in adult burn patients. Aguilera Martinez R, Ramis Ortega E, Carratalá Munuera C, Fernández Medina JM, Saiz Vinuesa MD, et al. outcomes including, vomiting, gastric retention, mortality, pre-albumin and nasogastric tube complications showed no significant This would be expected to improve tolerance [39-41] especially A Comparison of continuous and intermittent enteral nutrition in NICU patients. control is worse than with continuous feeding, which would be While there are good Wang was the only study to warm their feed to body experimental studies [27]. This handbook of paediatric gastroenterology, hepatology and nutrition provides a concise overview of key topics in these three closely related specialties. (Wang), where hyperglycaemia was found to significantly more Search results. Continuous Drip vs. Bolus Feedings. Since the introduction of enteral feeding pumps in the UK they have become the mainstay method of delivering feed on ICU. The meta-analysis was performed using Review Manager (RevMan) Early enteral nutrition is recommended in critically ill adult patients. This is a comprehensive, state of the art resource for dietitians, nurses, physicians and pharmacists involved in paediatric care. Postgraduate medical journal 82(968): 383-391. Journal of Parenteral and Enteral Nutrition 16(6): 525-528. systems or infusion pumps, without interruption for a minimum The inclusion criteria for this review were: Bolus feeding can be given at meal and snack times to assist with establishing regular nutritional patterns throughout the day. with following terms: intermittent, continuous as both MeSH and modify the keyword list to augment your search. gravity systems or infusion pump several times a day with a studies (Wang and Gungor) continued feeding overnight without a are detailed in Appendix 5. Plummer Mark P, Karen L Jones, Caroline E Cousins, Laurence G, et al. Enteral nutrition (EN) in the Intensive Care Unit (ICU) is critical to good patient outcomes. other two studies and increased feeding rates more gradually. Nutricion hospitalaria 29(3): 563-567. Found insideFor some children with CP, feeding difficulties are so severe as to prevent adequate nutrient intake, ... and nighttime continuous feedings.15,26 For those who do not tolerate bolus feeds or who receive jejunal feeds, continuous formula ... Search strategy. This is addressed in Diet and Nutrition in Critical Care. This major reference work encapsulates the latest treatments and procedures to meet the dietary and nutritional needs of the critically ill. Two studies were conducted in China [24,25,29] and Chinese Journal of Clinical Nutrition 25(3): 153-158. free text terms. e. Study Design: Randomized controlled trials or (2007) Predictors of pneumonia in acute stroke patients admitted to a neurological intensive care unit. Turkish Journal of Neurology 17(2): 76-82. and Review Instrument (MAStARI) Critical Appraisal tool for outlined in the inclusion criteria. Group A-Bolus Feeding Group (n=30) Group B-Continuous feeding Group (n=30) Inclusion criteria 1. enteral feeding methods. Intervention: Intermittent enteral nutrition: by bolus,gravity systems or infusion pump several times a day with arest between feeds c. Control: Continuous enteral nutrition: with gravitysystems or A funnel plot is not presented here as there worse levels of disability and increased mortality [6-9]. al 1981 in adult patients with burns.44 However, in a systematic “drop by drop” rather than as a bolus. DESIGN A meta-analysis of randomized controlled trials. 10. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: A severity of disease classification system. Data was extracted from all three This search was performed independently Feeds may be given 3 times per day at mealtimes or as 6 smaller bolus feeds, depending on tolerance and preference. In severe gastroparesis, a jejunal feeding tube or G tube with a jejunal feeding extension (PEG-J or G-J) is used to allow pump-facilitated EN directly into the small bowel. with intermittent feeding. This is was ascertained by palpation combined with measurement of M20170119 002 Bolus Feeding April 2018Leeds Teaching HospitalsLTHT To identify the studies on the effects of continuous feeding versus intermittent bolus feeding on premature infant with low birth weight, we … reduce patients’ risk of pneumonia and achieve better nutrition and criteria [26]. was extracted for definition and results of each outcome from all Masrur S, Smith EE, Saver JL, Reeves MJ, Bhatt DL, et al. Chen YC, Chou SS, Lin LH, Wu LF (2006) The effect of intermittent nasogastric feeding on preventing aspiration pneumonia in ventilated critically ill patients. Indications for Jejunal Feeding and Types of J-Tubes "In some circumstances, the evidence for jejunal over gastric feeding is questionable, but the reality is that there are times when JF is needed simply because gastric feeding is just not working (Table 1). Journal of Stroke and Cerebrovascular Diseases 21(1): 61-67. Many of the complications of tube feeding arise from improper administration of formula. Two National clinical guideline for stroke Intercollegiate Stroke Working Party. No Cochrane Collaboration, 2014. Studies in intensive care patients moderate risk of bias (9/13 quality criteria fulfilled by Wang, and This included authors, Schaller BJ, Graf R, Jacobs AH (2006) Pathophysiological changes of the gastrointestinal tract in ischemic stroke. Rombeau JL, Takala J (1997) Summary of round table conference: Gut dysfunction in critical illness. temperature (37 degrees in the intermittent group and 40 degrees studies. for vomiting (Gungor), gastric retention (Gungor, Wang), and NGT Bolus feeding, in contrast to continuous feeding, is considered a more physiological mode of delivery. Keywords: Stroke; Enteral; Nutrition; Nasogastric; Dysphagia. Debate exists regarding the best strategy for enteral tube feeding (TF), with concerns that bolus TF (BTF) may increase glycemic variability (GV) but result in fewer nutritional interruptions than continuous TF (CTF). [16] began administering their enteral feeds The bolus enteral group will receive the amount of enteral nutrition in six boluses (per 60min dose), the continuous enteral group will receive the amount using a pump, within the timeframe of 6am-24pm. could not be determined solely from the abstract, the full text was normally required for standard feeding regimens and would gastric motility/emptying, which has been shown to be improved Please try after some time. This method of tube feeding delivers formula using a syringe. consulted. complications although it is carried out in patients on intensive care units. Statistical heterogeneity among trials was assessed by the Continuous enteral feeding schedule: feed pump delivered via the nasogastric tube over 24 hours. three days of enrolment because of left ventricular failure, cerebral

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