75th Army Group Hospital, Dali, Yunnan, China.
Department of Neurology, The General Hospital of Northern Theater Command, Shenyang, Liaoning, China.
Int J Nurs Stud. 2021 Jan;113:103783. doi: 10.1016/j.ijnurstu.2020.103783. Epub 2020 Oct 21.
Enteral formula delivery strategy is an important part of enteral nutrition. We aimed to synthesize up-to-date studies to clarify the effects of intermittent versus continuous feeding on feeding intolerance during enteral nutrition in critically ill adults.
A meta-analysis of randomized controlled trials.
Embase, PubMed, Information Sciences Institute Web of Science, CINAHL EBSCO, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, China National Knowledge Infrastructure databases were searched from inception to 17th of June 2020.
The Cochrane "risk of bias" tool was used to assess the quality of individual studies, and the quality of each outcome was assessed by GRADE approach. Fixed or random effect meta-analysis was used pending the presence of heterogeneity. Dichotomous data synthesis was presented as risk ratio and 95% confidence interval, and quantitative data synthesis was shown as mean difference and 95% confidence interval.
Fourteen trials with 1025 critically ill adults were included in the meta-analysis. We found that intermittent feeding could significantly increase the occurrence of feeding intolerance (risk ratio = 1.64, 95% confidence interval = 1.23 to 2.18, P < 0.001) compared with continuous feeding, as well as the incidence of high gastric volume (risk ratio = 3.62, 95% confidence interval = 1.43-9.12, P = 0.006) and aspiration (risk ratio = 3.29, 95% confidence interval = 1.18-9.16, P = 0.02) in > 1-week trial duration, while constipation rate was reduced in intermittent feeding group (risk ratio = 0.66, 95% confidence interval = 0.45-0.98, P = 0.04). Patients in intermittent feeding group received more calories compared with continuous feeding group (mean difference = 184.81, 95% confidence interval = 56.61-313.01, P = 0.005). The quality of all evidence synthesis was "low" or "very low".
In critically ill adults, continuous feeding was associated with lower overall incidence of feeding intolerance, especially in high gastric volume and aspiration. However, decreased constipation incidence and more calorie intake were observed in intermittent feeding group. Because quality of the synthesized evidence was "low" or "very low", there is considerable uncertainty about this estimate.
肠内配方的输送策略是肠内营养的重要组成部分。我们旨在综合最新研究结果，阐明在危重症成人中，肠内营养时间歇性与连续性喂养对喂养不耐受的影响。
随机对照试验的荟萃分析。
从建库至 2020 年 6 月 17 日，我们在 Embase、PubMed、信息科学研究所 Web of Science、CINAHL EBSCO、Cochrane 对照试验中心注册库、中国生物医学文献数据库、中国知网数据库中进行了检索。
我们使用 Cochrane“偏倚风险”工具评估单个研究的质量，并使用 GRADE 方法评估每个结局的质量。存在异质性时，采用固定或随机效应荟萃分析。二分类数据的综合采用风险比和 95%置信区间表示，定量数据的综合采用均数差和 95%置信区间表示。
荟萃分析纳入了 14 项涉及 1025 例危重症成人的试验。我们发现，与连续性喂养相比，间歇性喂养可显著增加喂养不耐受的发生（风险比=1.64，95%置信区间=1.23 至 2.18，P<0.001），以及在>1 周试验持续时间时胃内容量过高（风险比=3.62，95%置信区间=1.43 至 9.12，P=0.006）和误吸（风险比=3.29，95%置信区间=1.18 至 9.16，P=0.02）的发生率，而间歇性喂养组的便秘发生率降低（风险比=0.66，95%置信区间=0.45 至 0.98，P=0.04）。与连续性喂养组相比，间歇性喂养组的患者接受了更多的热量（均数差=184.81，95%置信区间=56.61 至 313.01，P=0.005）。所有证据综合的质量均为“低”或“极低”。
在危重症成人中，连续性喂养与喂养不耐受的总发生率较低相关，特别是胃内容量过高和误吸方面。然而，间歇性喂养组便秘发生率降低且热量摄入增加。由于综合证据的质量为“低”或“极低”，对这一估计存在相当大的不确定性。
