medigraphic.com
ISSN 2448-8909 (Print)

2016, Number 3

<< Back Next >>

Med Crit 2016; 30 (3)

Enteral feeding tolerance in continuous infusion vs bolus, measured by intraabdominal pressure and carbon dioxide production at end expiration «VCO2», in critically ill patients

Aguilar AMF, Assy CDA, Góngora MJJ, López AVG, Cetina CMA, Magdaleno LGA

Language: Spanish
References: 17
Page: 171-177
PDF size: 201.43 Kb.


ABSTRACT

Background: Nutritional therapy is fundamental on critically ill patients care, being enteral feeding the preferred mode. The aim of this study was to evaluate enteral feeding tolerance by measuring intraabdominal pressure fluctuations and carbon dioxide production at end expiration (VCO2) comparing two modalities: continuous infusion versus bolus.
Methods: This study was an open, controlled, clinical trial enrolling 76 patients. Demographic data, severity scales and diagnosis was obtained by ICU admission. Patients were randomized in two groups: I Group, 37 members, received enteral nutritional support in 3 periods with an 8 hour infusion length each one. B Group, 39 members, received enteral feeding in bolus with a max amount of 500 cc given in less than an hour. Six measurements of intraabdominal pressure (IAP) were made daily while giving nutritional support. VCO2 was checked every hour through Draguer Evita XL® ventilator. Residual gastric volume, mechanical ventilation associated pneumonia, mechanical ventilation length, ICU length of stay and mortality were recorded.
Results: On Group I IAP increased 29% and VCO2 3.8% and on B Group IAP increased 78% and VCO2 43%, both differences were statistically significant (p = 0.001 and p = 0.002 respectively).
Conclusion: There is a better feeding tolerance giving enteral nutrition support by continuous infusion than bolus, confirming with intraabdominal pressure measurement and carbon dioxide production at end expiration.


REFERENCES

  1. Fernández F, Ordóñez F, Blesa A. Soporte nutricional del paciente crítico: ¿a quién, cómo y cuándo? Nutr. Hosp 2005; 20(2): 9-12 Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0212-16112005000500003&lng=es

  2. Kliger G, Perman M, Echenique S, Placido J. Terapia nutricional en el paciente crítico. Nutrición enteral y parenteral. 2°ed. México: McGraw Hill; 2012. p. 315-332.

  3. García Vila B, Grau T. La nutrición enteral precoz en el enfermo grave. Nutr Hosp. 2005;20(2):93-100.

  4. Botello J, González A. Nutrición enteral en el paciente crítico. Arch Med. 2010;10(2)163-169.

  5. Figueredo R, Mendoza L, Chirife G, Ayala F, Jiménez C, Lawes C. Bases fisiológicas de la nutrición enteral. En: Anaya PR, Arenas MH, Arenas MD., editores. Nutrición enteral y parenteral. 2o ed. México: McGraw Hill; 2012. p. 155-159.

  6. Centro Nacional de Excelencia Tecnológica en Salud. México: CENETEC; 2012. Nutrición enteral: Fórmulas, Métodos de Infusión e Interacción Fármaco Nutriente. [54 páginas]

  7. Sanz-París A, Lázaro J, Guallar A, Gracia P, Caverni A, Albero R. Nutrición enteral continua frente a nutrición en bolo: efectos sobre el péptido C urinario y el balance nitrogenado. Med Clin. 2005;124(16):613-615.

  8. Maurer A, Guzmán I, Mendoza A, Ramírez S. Monitorea y seguimiento del paciente con nutrición enteral. En: Anaya Prado R, Arenas M H, Arenas Moya D, editores. Nutrición enteral y parenteral. 2o ed. México: McGraw Hill; 2012. p 179-185.

  9. Rhoney DH, Parker D, Formea CM, Yap C, Coplin WM. Tolerability of bolus versus continuous gastric feeding in brain-injured patients. Neurol Res. 2002;24(6):613-620.

  10. Campbell IT, Morton RP, Cole JA, Raine CH, Shapiro LM, Stell PM. A comparison of the effects of intermittent and continuous nasogastric feeding on the oxygen consumption and nitrogen balance of patients after major head and neck surgery. Am J Clin Nutr. 2014;38(6):870-878. Disponible en: http://ajcn.nutrition.org/content/38/6/870.full.pdf

  11. Tavares V, Gómez P, Caporossi C. Enteral nutrition in critical patients; should the administration be continuous or intermittent? Nutr Hosp. 2014;29(3):563-567.

  12. Serpa F, Kimura M, Faintuch J, Ceconello I. Effects of continuous versus bolus infusion of enteral nutrition in critical patients. Rev Hosp Clin. 2003;58(1):9-14.

  13. MacLeod JB, Lefton J, Houghton D, Roland C, Doherty J, Cohn SM, et al. Prospective randomized control trial of intermittent versus continuous gastric feeds for critically ill trauma patients. J Trauma. 2007; 63(1):57-61.

  14. Sánchez-Miralles A, Castellanos G, Badenes R, Conejero R. Síndrome compartimental abdominal y síndrome de distrés intestinal agudo. Med Intensiva. 2013;37(2):99-109.

  15. Kirkpatrick A, Roberts D, De Waele J, Jaeschke R, Malbrain M, Keulenaer B, et al. Intraabdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. [revista en Internet]. 2013;39(7):1190-1206.

  16. Malbrain M, Cheatham M, Kirkpatrick A, Sugrue M, Parr M, DeWaele J, et al. Results from the International Conference of Experts on Intraabdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med. 2006;32(11):1722-1732. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/16967294

  17. Bejarano N, Navarro S, Rebasa P, García O, Hermoso J. Intraabdominal pressure as a prognostic factor for tolerance of enteral nutrition in critical patients. JPEN J Parenter Enteral Nutr; 37(3):352-360. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/2307013




2020     |     www.medigraphic.com