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Bolus vs Continuous Nasogastric Feeds in Mechanically Ventilated Pediatric Patients: A Pilot Study
Author(s) -
Brown AnnMarie,
Fisher Elaine,
Forbes Michael L.
Publication year - 2019
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1495
Subject(s) - medicine , parenteral nutrition , bolus (digestion) , enteral administration , malnutrition , pediatric intensive care unit , anesthesia , pediatrics
Background Malnutrition increases the risk of mortality and morbidity in the pediatric intensive care unit (PICU). Barriers to adequate delivery of enteral nutrition (EN) include hemodynamic instability, feeding interruptions and intolerance, and lack of standardized feeding protocols. The most recent guidelines on nutrition support for the critically ill child describe a paucity of evidence around the best method to deliver EN. There is an untested clinical assumption that bolus gastric feeding (B‐GF) in intubated patients is associated with aspiration events, lung injury, and associated morbidity compared with continuous gastric feeding (C‐GF). This study compared the effectiveness and safety of C‐GF vs B‐GF in intubated pediatric patients. Methods We enrolled randomized patients aged 1 month–12 years who were intubated within 24 hours and received EN starting within 48 hours of admission to a C‐GF or B‐GF group. Goal‐directed EN volume and caloric density were increased every 3 and 12 hours, respectively, to target. Feeding interruptions and intolerance events were recorded. Results Twenty‐five subjects were enrolled (B‐GF = 11; C‐GF = 14). At 24 hours, B‐GF was associated with higher energy and protein delivery ( P < 0.007) and was associated with faster time to goal volume (median B‐GF = 15 hours; C‐GF = 29.5 hours). No aspiration events resulting in additional lung injury were noted for either group ( P = 0.866). Conclusions B‐GF was associated with superior delivery of EN with a comparable safety profile to C‐GF. Further study is needed to compare both EN methods in other PICU populations.