Data_Sheet_3_The effect of intermittent versus continuous enteral feeding for critically ill patients: a meta-analysis of randomized controlled trials.docx

ObjectivesThe appropriate strategy for enteral feeding in critically ill patients still remains controversial. Therefore, we conducted this meta-analysis to compare the effect of intermittent versus continuous enteral feeding method for critically ill patients.
MethodsElectronic databases including PubMed, Embase, Scopus, and Cochrane Library were searched up to April 10th, 2023 for randomized controlled trials evaluating the effect of intermittent versus continuous enteral feeding for critically ill patients. The primary outcomes were feeding intolerances, including diarrhea, vomiting, distension, constipation, gastric retention, and aspiration pneumonia. The secondary outcomes were mortality in intensive care unit (ICU), length of stay in ICU, and achievement of nutritional goal.
ResultsThirteen studies with a total of 884 patients were analyzed in this meta-analysis. Overall, the use of intermittent enteral feeding was associated with higher incidence of diarrhea (OR 1.66, 95%CI 1.13 to 2.43, I2 = 16%) and distension (OR 2.29, 95%CI 1.16 to 4.51, I2 = 0%), lower incidence of constipation (OR 0.58, 95%CI 0.37 to 0.90, I2 = 0%), and longer length of ICU stay (MD 1.09, 95%CI 0.53 to 1.64, I2 = 0%). Moreover, no significant difference was identified for other outcome measures.
ConclusionIn critically ill patients, the implementation of intermittent enteral feeding was associated with higher incidence of diarrhea and distension, longer length of ICU stay, but lower occurrence of constipation. Nevertheless, the absence of sufficient high-quality randomized controlled clinical trials precludes any definitive conclusions regarding the optimal approach to enteral feeding in this population. There is an imperative need for more studies to further assess the efficacy of the two enteral feeding strategies.

研究目的：重症患者肠内营养（enteral feeding）的适宜策略仍存在争议。为此，本研究开展此项荟萃分析，对比间歇性与持续性肠内营养方案用于重症患者的临床效果。
研究方法：检索截至2023年4月10日的PubMed、Embase、Scopus及Cochrane Library电子数据库，筛选评估间歇性与持续性肠内营养对重症患者影响的随机对照试验（randomized controlled trial）。主要结局指标为喂养不耐受，包括腹泻、呕吐、腹胀、便秘、胃潴留及吸入性肺炎；次要结局指标为重症监护病房（ICU）病死率、ICU住院时长及营养目标达成率。
研究结果：本荟萃分析共纳入13项研究，合计884例患者。总体而言，采用间歇性肠内营养的患者腹泻（比值比（odds ratio, OR）=1.66，95%置信区间（95% confidence interval, 95%CI）：1.13~2.43，异质性指数I²=16%）与腹胀（OR=2.29，95%CI：1.16~4.51，I²=0%）的发生率更高，便秘发生率更低（OR=0.58，95%CI：0.37~0.90，I²=0%），且ICU住院时长更长（均数差（mean difference, MD）=1.09，95%CI：0.53~1.64，I²=0%）。此外，其余结局指标未发现显著统计学差异。
研究结论：对于重症患者，实施间歇性肠内营养与更高的腹泻、腹胀发生率及更长的ICU住院时长相关，但便秘的发生率更低。然而，目前尚缺乏足够高质量的随机对照临床试验，无法就该人群肠内营养的最优方案得出确定性结论，亟需开展更多研究以进一步评估两种肠内营养策略的临床疗效。