Continuous or Intermittent? Which Regimen of Enteral
Nutrition is Better for Acute Stroke Patients? a Systematic
Review and Meta-Analysis
Volume 3 - Issue 3
Giovanni Di Paolo*, Elizabeth Twomlow, Fahmy WF Hanna, Adam D Farmer, Joanne Lancaster, Julius Sim and
Christine Roffe
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- Royal Stoke University Hospital, The Guy Hilton Research Centre, United Kingdom
*Corresponding author:
Giovanni Di Paolo, Guy Hilton Research Centre, Stoke-on-Trent, United Kingdom
Received: October 23, 2019; Published: November 07, 2019
DOI: 10.32474/OJNBD.2019.03.000163
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Abstract
Background and purpose: Enteral nutrition via nasogastric tube in acute stroke patients with dysphagia is an important
determinant of patient outcomes. It is unclear whether intermittent or continuous feeding is more efficacious. The aim of this
review is to examine the current evidence comparing the effectiveness of intermittent versus continuous feeding in stroke patients
in terms of nutritional status, gastrointestinal intolerance and other complications.
Methods: A systematic review of randomized controlled studies comparing intermittent with continuous nasogastric feeding
in acute stroke patients was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Metaanalyses)
guidance using predefined search terms. The search was conducted in MEDLINE and EMBASE up to 1st March 2019.
Two independent reviewers assessed study quality using the Joanna Briggs Institute Critical Appraisal Tool. Meta-analyses were
conducted, where appropriate, using a random-effects model to pool risk ratio with corresponding 95% CI.
Results: Three studies including a total of 184 patients were identified. All three were medium to low quality. The definition of
intermittent enteral nutrition within each study varied considerably in terms of volume, rate and mode of delivery. Achievement of
nutritional targets was the same for both feeding patterns in the one study it was reported. Only aspiration pneumonia and diarrhea
were measured by all three studies. There was no significant difference in the incidence of aspiration pneumonia (RR 0.91, 95% CI
0.53-1.57, p=0.74, I2=50%) and diarrhea (RR 1.74, 95% CI 0.70-4.30, p=0.23, I2=42%) between the two patterns of feeding. Other
outcomes including, vomiting, gastric retention, mortality, pre-albumin and nasogastric tube complications showed no significant
differences.
Conclusion: There is very little and low-quality evidence to inform patterns of enteral feeding after stroke. The available
evidence shows no significant difference in nutritional achievement and complications between intermittent and continuous
nasogastric tube feeding in acute stroke patients.
Keywords: Stroke; Enteral; Nutrition; Nasogastric; Dysphagia
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