A comparison of continuous and intermittent Enteral nutrition in cerebrovascular patients

Abstract

Objective: Dysphagia and malnutrition are not so rare in stroke patients, and have an unfavorable influence on recovery. Nutritional support may reduce infections, duration of hospital stay and mortality. However, there is no clear evidence about the modality of nasogastric nutrition. In this study, intermittent and continuous enteral nutrition were compared regarding the development of pulmonary infections and gastrointestinal tolerance in acute cerebrovascular patients. Patients and Methods: Sixty-two acute cerebrovascular patients with dysphagia were enrolled in the study. The same volume of nutrition product was infused four times daily in 31 patients and continuously for 24 hours in the remaining 31. After 10 days of follow- up, the rates of pulmonary infections, diarrhea, increased gastric residual volumes, vomiting, and tube occlusion were compared between the two groups. Results: Twenty patients developed pneumonia (32%) and 8 (13%) diarrhea. Mortality due to complications associated with tube feeding was 6%. Aspiration and related pneumonia was present in 11 (35%) patients in the intermittent nutrition group and in 9 (29%) patients in the continuous nutrition group. The rate of pulmonary infection was not statistically different between the two groups (p> 0.05). Diarrhea was observed in 7 (23%) intermittently fed patients and in only 1 (3%) patient in the continuously fed group. Diarrhea was more common in the intermittent nutrition group, and the difference approached statistical significance (p= 0.05). None of the patients developed tube occlusion, vomiting or gastric retention. The rate of mortality and the interruption of feeding was not significantly different between the two groups (p> 0.05). Conclusion: Diarrhea and pulmonary infections are more prevalent with intermittent tube feeding compared to continuous enteral nutrition, though the difference is not so conspicuous. This may be due to contamination of the equipment and feeding solution because of frequent manipulation and interruption of infusion. Continuous infusion should be preferred in acute stroke patients requiring nasogastric feeding.