McNelly, AS;
Bear, DE;
Connolly, BA;
Arbane, G;
Allum, L;
Tarbhai, A;
Cooper, JA;
... Puthucheary, ZA; + view all
(2020)
Effect of Intermittent or Continuous Feed on Muscle Wasting in Critical Illness: A Phase 2 Clinical Trial.
Chest
, 158
(1)
pp. 183-194.
10.1016/j.chest.2020.03.045.
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Montgomery_ivc paper CHEST-19-2845 v3 090320 CLEAN.pdf - Accepted Version Download (872kB) | Preview |
Abstract
BACKGROUND: Acute skeletal muscle wasting in critical illness is associated with excess morbidity and mortality. Continuous feeding may suppress muscle protein synthesis as a result of the muscle-full effect, unlike intermittent feeding which may ameliorate it. RESEARCH QUESTION: Does intermittent enteral feed decrease muscle wasting compared with continuous feed in critically ill patients? STUDY DESIGN AND METHODS: In a Phase II interventional single-blinded randomized controlled trial, 121 mechanically-ventilated adult patients with multi-organ failure were recruited following prospective informed consultee assent. They were randomized to the intervention group (intermittent enteral feeding from six four-hourly feeds per 24 hours, n=62) or control group (standard continuous enteral feeding, n=59). The primary outcome was ten-day loss of rectus femoris muscle cross-sectional area determined by ultrasound. Secondary outcomes included nutritional target achievements, plasma amino acid concentrations, glycaemic control and physical function milestones. RESULTS: Muscle loss was similar between arms (-1.1% (95%CI -6.1, -4.0); p=0.676). More intermittently fed patients received 80% or more of target protein (OR 1.52 (1.16-1.99); p<0.001) and energy (OR 1.59 (1.21-2.08); p=0.001). Plasma branched-chain amino acid concentrations before and after feeds were similar between arms on trial day 1 (71 μM (44-98); p=0.547) and trial day 10 (239 μM (33-444); p=0.178). During the 10-day intervention period the coefficient of variation for glucose concentrations was higher with intermittent feed (17.84 (18.6-20.4) versus continuous feed (12.98 (14.0-15.7); p<0.001). However, days with reported hypoglycaemia and insulin usage were similar in both groups. Safety profiles, gastric intolerance, physical function milestones and discharge destinations did not differ between groups. INTERPRETATION: Intermittent feeding in early critical illness is not shown to preserve muscle mass in this trial despite resulting in a greater achievement of nutritional targets than continuous feeding. However, it is feasible and safe.
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