A randomized controlled trial to compare the efficacy and safety of continuous, intermittent and bolus enteral feeding in critically ill patients

Enteral nutrition (EN) delivers nutrition directly into the gastrointestinal tract and is preferred over parenteral nutrition (PN) due to its physiological benefits, preservation of gut integrity, lower complication risks, and immune advantages. It is widely used in acute, sub-acute, rehabilitation, and long-term care settings, and can be administered as continuous, cyclic, intermittent, or bolus feeding. Intermittent feeding, usually given over 20–60 minutes four to six times daily, is more physiological and allows patient mobility, but carries risks such as aspiration, diarrhea, and gastric distension. Bolus feeding, delivered rapidly via syringe or gravity drip three to six times daily, mimics normal meal patterns and enhances patient independence, though it may increase aspiration risk and cause osmotic diarrhea or delayed gastric emptying with certain formulas.

For critically ill patients, including those intubated, with poor glycemic control, receiving jejunal feeds, or unable to tolerate intermittent schedules, continuous EN via a pump or gravity bag at a set hourly rate is often preferred. Continuous feeding improves tolerance, reduces gastric residuals, and decreases aspiration risk but requires specialized equipment, restricts mobility, and increases costs. Comparative studies suggest continuous feeding offers better tolerance and lower gastric residuals than intermittent or bolus methods, though intermittent and bolus feeding are more physiological. However, no single study has compared all three methods directly, highlighting the need for further research.