Rozhl Chir. 2021 Spring;100(2):66-73.
Nutrition therapy becomes one of the fundamental conditions of a successful outcome in malnourished patients and in critically ill patients. The administration of enteral feeding in critically ill patients is mostly performed by continuous or cyclic feeding. On the contrary, the potential benefits of intermittent feeding include increased muscle protein synthesis. This review outlines the theory of a possible anabolic effect of intermittent feeding. The authors describe their experience with implementation of this method of administration in the intensive care unit including the follow-up of possible complications and adverse effects.
Six patients with intermittent feeding were followed retrospectively during the study period. In addition to demographic data, potential complications related to intermittent enteral feeding (aspiration pneumonia, increased gastric residual volume, abdominal discomfort, osmotic diarrhoea) were evaluated.
The average time of intermittent feeding was 8 days. The sum of intermittent feeding days was 63. No aspiration followed by pneumonia was detected during this period. The gastric residual volume did not increase, either. Abdominal discomfort and osmotic diarrhoea were not observed in any patient.
Although continuous and cyclic enteral feeding in critically ill patients remains the standard and the most common practice, it is considered as a non-physiological method with possible negative consequences for the patient. On the other hand, intermittent feeding is theoretically associated with respecting of the circadian rhythm and with activation of autophagy. Intermittent feeding increases muscle protein synthesis and supports the release of fatty acids. As shown by our observational study, intermittent administration of enteral nutrition in intensive care can be implemented without any adverse effects; however, it is more time consuming for the nurses.
营养疗法是营养不良患者和重症患者获得成功治疗结果的基本条件之一。在重症患者中，肠内喂养大多通过连续或循环喂养来进行。相反，间歇性喂养的潜在益处包括增加肌肉蛋白质合成。本文综述了间歇性喂养可能具有合成代谢作用的理论。作者描述了他们在重症监护病房实施这种管理方法的经验，包括对可能出现的并发症和不良反应的随访。
在研究期间，对 6 例接受间歇性喂养的患者进行了回顾性随访。除了人口统计学数据外，还评估了与间歇性肠内喂养相关的潜在并发症（吸入性肺炎、胃残留量增加、腹部不适、渗透性腹泻）。
间歇性喂养的平均时间为 8 天。间歇性喂养的总天数为 63 天。在此期间，没有出现因间歇性喂养而导致的肺炎。胃残留量也没有增加。没有患者出现腹部不适或渗透性腹泻。
尽管连续和循环肠内喂养仍然是重症患者的标准和最常见的方法，但它被认为是一种非生理方法，可能对患者产生负面影响。另一方面，间歇性喂养理论上与尊重昼夜节律和自噬的激活有关。间歇性喂养增加肌肉蛋白质合成并支持脂肪酸的释放。正如我们的观察性研究所示，重症监护中间歇性给予肠内营养可以实施，而不会产生任何不良反应；但是，这会增加护士的工作时间。
