Safety and efficacy of continuous or intermittent enteral nutrition in ICU patients: systematic review of clinical evidence

The best mode of delivering enteral nutrition (EN) in ICU is still debated: several consensus guidelines (ASPEN and ESPEN) suggest that EN in ICU should be preferably delivered continuously rather intermittently but some authors highlight that the first is unphysiological. The aim of this systematic review (SR) is to summarize available clinical evidence related to safety and efficacy of continuous enteral nutrition (C-EN) or intermittent enteral nutrition (I-EN) in ICU patients, in relation to appropriated supply on nutritional status, gastrointestinal symptoms or tolerance, risks on respiratory tract infections. A literature search of Pubmed, EMBASE and Google Scholar was performed comparing C-EN vs I-EN and 4196 published studies were screened. Nineteen studies were selected for this SR reporting types of ICU, nutritional protocols and study period. Effects of C-EN vs I-EN were presented according to the impact on: nutritional status, digestive tract and respiratory tract. The contrasting results confirmed that the optimal delivering mode of EN remains controversial. Future studies dedicated to identify the benefits and limitations of C-EN or I-EN should be realized