A More Physiological Feeding Process in ICU:the Intermittent Infusion With Semi-solidification of Nutrients
Condition: Nutrition, Enteral
Study type: Interventional

Summary: 
      Malnutrition and underfeeding are major challenges in caring for critically ill patients.
      Continuous feeding were thought to be better tolerated by patients with the limited
      absorptive gut surface area or gastrointestinal dysfunction, but associated with more tube
      clogging and required the patient to be attached to an infusion pump for significant periods
      of time. Intermittent infusion resembled more physiological feeding process, which allowed
      greater patient mobility and might reach goal enteral calories earlier, and the latter were
      considered to effectively decrease the length of stay (LOS)-in-hospital and mortality.
      However, it also had some previous study found that intermittent infusion had more
      complications, such as diarrhea, regurgitation than continuous. Some study found that it was
      an efficient way to prevent aspiration and reflux by increasing the enteral nutrient solution
      viscosity and improve bolus intermittent feeding intolerance. The primary goal of this was to
      study whether receiving semi-solidification of nutrients could increase the percent
      prescribed calories received by improving the feeding intolerance, and secondary goal was to
      observing the effect of semi-solid nutrient to the LOS of ICU and in-hospital, lung
      infection, 30-days mortality and the glycemic variability (GV).
    

Detailed description: 
      Enteral nutrition (EN) therapy is an essential part in critically ill patients，and can be
      administered on a continuous or intermittent, but there were no consensus on which should be
      adopted. Continuous feeding were thought to be better tolerated by patients with the limited
      absorptive gut surface area or gastrointestinal dysfunction, but associated with more tube
      clogging and required the patient to be attached to an infusion pump for significant periods
      of time. Intermittent infusion resembled more physiological feeding process, which allowed
      greater patient mobility and might reach goal enteral calories earlier, and the latter were
      considered to effectively decrease the LOS-in-hospital and mortality. However, it also had
      some previous study found that intermittent infusion had more complications, such as
      diarrhea, regurgitation than continuous.

      Recently, some study found that it was an efficient way to prevent aspiration and reflux by
      increasing the enteral nutrient solution viscosity and improve bolus intermittent feeding
      intolerance. In dementia or Parkinson's patients, one study showed that high-viscosity liquid
      meal could decrease the incidence of aspiration, compared with the thin liquid, but the study
      about the viscosity of nutrition was little and the sample size was small.

      In this study, the primary goal of this was to study whether receiving semi-solidification of
      nutrients could increase the percent prescribed calories received by improving the feeding
      intolerance, and secondary goal was to observing the effect of semi-solid nutrient to the LOS
      of ICU and in-hospital, lung infection, 30-days mortality and the glycemic variability (GV).
    

Intervention name(s): semi-solid agent with standard enteral feeding; standard enteral feeding
Intervention type(s): Dietary Supplement; Other
Intervention description(s): after infusion of semi-solid agent, Intermittent enteral feeding is applied less than 60 minutes; Intermittent enteral feeding is applied less than 60 minutes
Other intervention name(s): semi-solidification of nutrient; standard enteral nutrition
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: Semi-solidification; caloric debt; enteral nutrition; critical illness