Which is better for glycemic control? bolus, intermittent (nocturnal pause) or continuous enteral feeding in septic critically ill patients.

Background and

Objectives

Hypoglycaemia and intolerance may occur during enteral nutrition (EN) in patients with sepsis in the intensive care unit (ICU). Bolus, intermittent (continuous during the day with pauses at night), and continuous EN techniques may have different effects on these outcomes. Our primary aim was to assess the effects of these three EN methods on blood glucose levels (BGLs), with a secondary focus on their impact on the development of feeding intolerance.

Methods

This was a single-centre, prospective, randomised, controlled trial conducted in a tertiary-care adult ICU. After obtaining ethics committee approval and family consent, 93 patients with sepsis were and randomised into three groups: Bolus, intermittent, and continuous EN. BGLs were measured four times daily for 7 days. Outcomes evaluated included normoglycaemia (70-180 mg/dL), hypoglycaemia (BGL <70 mg/dL), hyperglycaemia (BGL >180 mg/dL with insulin requirement), time to target calorie (TC; defined as the day when 75% of the calculated caloric value was reached), and feeding intolerance-high gastric residual volume (defined as gastric residual volume of ≥250 mL).

Results

Intermittent feeding was associated with more unfluctuated/stable BGL within days and between days (p = 0.001 and p = 0.003, respectively). The bolus group had the highest risk and the intermittent group had the lowest risk of developing intolerance (p = 0.014). The continuous feeding group had the highest insulin requirement (p = 0.025). There were no significant differences between groups in terms of TC or requirement of dextrose administration (p = 0.414 and p = 0.579, respectively).

Conclusions

In ICU patients with sepsis, intermittent feeding provided superior glycaemic control and reduced risk of developing intolerance compared to bolus or continuous methods. The confirmation of these findings necessitates larger studies encompassing a broader cohort of patients.