Complications of enteral nutrition : a comparison of continuous and intermittent nasogastric feeding.

Abstract

The majority of hospitalized patients are at high risk of malnourishment causing poor recoveries. Nasogastric tube feeding is an artificial method in meeting nutritional needs when oral intake is not possible. Although beneficial, patients are exposed to various complications related to tube feeding intolerance. As a result, enteral feeds are decreased in frequency or withheld, depriving malnourished patients of their only source of nutrition. Locally as both methods of enteral feeding are used, a clinical question (PICO) was formulated: In nasogastric tube-fed patients, will continuous infusion feeding be a better strategy compared to intermittent bolus feeding in reducing complications such as diarrhea, vomiting and/or aspiration pneumonia? Nasogastric tube-fed patients were the population of interest; continuous infusion feeding was the intervention of interest compared with intermittent bolus feeding. The outcome of interest was to prevent complications. The main keywords identified from the PICO question were: “enteral nutrition”, “tube feeding methods”. A literature search was conducted to answer the chosen PICO question using various databases offered at the local library. The inclusion criteria applied were articles published in English or human participants, dated between the year 200 and the present day. The population of interest included late adulthood up to the elderly who were fed through a nasogastric tube. This study excluded neonates, percutaneous endoscopic gastrotomy and animals. Nine randomized controlled trials and one cohort study were selected as key papers using the hierarchy of evidence. A critical appraisal of all such studies was carried out using three main types of critical appraisal tools. The selected studies generated different conclusion related to intermittent bolus feeding and continuous pump feeding. No difference was noted between both modes of enteral feeding in preventing gastrointestinal disturbances. Hence, such findings were inconclusive in response to the chosen PICO question. Findings from this study demonstrated the need for realistic future recommendations within the local context. Evidence-based guidelines and ongoing consultation with a multidisciplinary team were suggested as practice and management recommendations. In line with education and research recommendations, nursing curriculums should include enteral nutrition as part of the nursing credit system, as well as the need of a comparative study to compare local findings with foreign findings.