Prospective Randomized Evaluation of Two Regimens for Converting from Continuous to Intermittent Feedings in Patients with Feeding Gastrostomies

Abstract

Forty enterally fed male patients were randomized to one of two regimens designed to determine the better means of converting them from continuous to intermittent enteral feedings. All patients received a nutritionally complete iso-osmolal 1 kcal/cc formula containing 6 g of nitrogen/L beginning on the second postgastrostomy day. Half of the patients (20) were randomized to a discontinuous regimen abruptly changing from continuous to gradually increasing intermittent feedings until reaching their nutritional goals. Intravenous fluids were given to maintain normal fluid balance. The other 20 patients were randomized to an overlapping regimen, receiving continuous feedings at a decreasing rate while intermittent feedings were progressively increased. Intravenous fluids were used during the first three stages only. There were no significant differences (p < 0.05) in major diagnosis, type of gastrostomy, age, weight, height, admission or discharge serum albumin concentration, calculated basal energy expenditure (BEE), or nutrient goals (1.5 x BEE, 1.5 g of protein/kg per day). The overlapping regimen resulted in a significant reduction in the total hospital stay measured in days (10.4 ± 2.45 vs 15.76 ± 3.9) (p < 0.05). The overlapping regimen-managed patients maintained nutritional goals for a significantly greater percentage of the total hospital stay (65.35 ± 10.22% vs 31.85 ± 18.2%) ( p < 0.05), had a significantly higher nitrogen balance (N BAL) (g/24 hours) [N BAL = Nitrogen in-(urine urea nitrogen + 4) (3.17 ± 0.56 vs 2.63 ± 0.55) (p < 0.05), had fewer days of intravenous fluids (3.1 ± 0.46 vs 10.35 ± 3.33) (p < 0.05), and had less diarrheal episodes (3 vs 9) (p < 0.05), aspiration (0 vs 1) (p < 0.05), and vomiting (0 vs 4) (p < 0.05) vs the discontinuous regimen-managed patients. We conclude that the use of an overlapping regimen is nutritionally and economically more efficient than a discontinuous one. (Journal of Parenteral and Enteral Nutrition 15: 405-407, 1991)