Efecto de la nutrición enteral continua vs intermitente en la evolución clínica de lactantes en estado crítico

Abstract

Introduction: Enteral nutrition (EN) en the critical ill patient is a controversial topic. This controversy stems from the fact that there is great variability in the way that Intensive Care Units (ICU) administer EN; parameters like when to initiate, what route to use, how to deliver and how better use the algorithms based in the clinical status of the patient are still without a consensus. There are several studies comparing the use of continuous versus intermittent gastric feeding. These studies look at several parameters such as medical complications and the achievement of pre-established nutritional goals. Studies done in adults has not shown significant differences in the incident of complications. Very few studies have been done in children.Methods: Data was collected from two cohorts from the ICU 1 at the Hospital del Nino Dr. José Renán Esquivel: ninety-eight patients who received continuous infusion EN from the year 2016 and ninety patients who received intermittent EN from the year 2012. Both group were on mechanical ventilation.Results: Demographic characterics were similar in both groups, with the exception of the means of age, which was higher in the cases of the year 2016 (7.9 vs 5.4 months, p=0.00) and the mean time to initiate EN. It was lower in the cases 2016 (14.2 vs 19.2 hours, p=0.00). It was shown that continuous feeding increases the probability of achieving 75% of the caloric goal 1.7 times (Cl=1.3-2.2). In the group receiving continuous feeding, patient who achieved 75% and 100% of caloric goals did it faster than in the control group, p=0.00 and 0.02, respectively. We did not find association between the EN and the development of infections, time spent on the mechanical ventilation, length of stay in the ICU and mortality.Conclusions: The use of continuous EN increases the probability of achieving 75% of the caloric goal for the patient and allows to achieve 75% and 100% of the caloric goal faster that bolus nutrition. The development of infections, time spend on the mechanical ventilation, length of stay in the ICU and mortality were similar in both groups.