RT Journal Article
SR Electronic
T1 Does intermittent nutrition enterally normalise hormonal and metabolic responses to feeding in critically ill adults? A protocol for the DINE-Normal proof-of-concept randomised parallel-group study
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e086540
DO 10.1136/bmjopen-2024-086540
VO 14
IS 11
A1 Beattie, Clodagh Emer
A1 Thomas, Matt
A1 Borislavova, Borislava
A1 Smith, Harry A
A1 Ambler, Michael
A1 White, Paul
A1 Hayes, Kati
A1 Milne, Danielle
A1 Ramesh, Aravind V
A1 Gonzalez, Javier T
A1 Betts, James A
A1 Pickering, Anthony E
YR 2024
UL http://bmjopen.bmj.com/content/14/11/e086540.abstract
AB Introduction Over half of patients who spend >48 hours in the intensive care unit (ICU) are fed via a nasogastric (NG) tube. Current guidance recommends continuous delivery of feed throughout the day and night. Emerging evidence from healthy human studies shows that NG feeding in an intermittent pattern (rather than continuous) promotes phasic hormonal, digestive and metabolic responses that are important for effective nutrition. It is not yet known whether this will translate to the critically ill population. Here, we present the protocol for a proof-of-concept study comparing diurnal intermittent vs continuous feeding on hormonal and metabolic outcomes for patients in the ICU.Methods and analysis The study is a single-centre, prospective, randomised, open-label trial comparing intermittent enteral nutrition with the current standard practice of continuous enteral feeding. It aims to recruit participants (n=30) needing enteral nutrition via an NG tube for >24 hours who will be randomised to a diurnal intermittent or a continuous feeding regimen with equivalent nutritional value. The primary outcome is peak plasma insulin/c-peptide within 3 hours of delivering the morning intermittent feed on the second study day, compared with that seen in the continuous feed delivery group at the same time point. Secondary outcomes include feasibility, tolerability, efficacy and metabolic/hormonal profiles.Ethics and dissemination We obtained ethical approval from the Wales Research Ethics Committee 3 prior to data collection (reference 23/WA/0297). We will publish the results of this study in an open-access peer-reviewed journal.Trial registration number NCT06115044.