Protocol for a systematic review and meta-analysis investigating the impact of continuous versus intermittent enteral feeding in critically ill patients

Abstract

Abstract Introduction: Enteral nutrition (EN) is the recommended nutritional support in most critically ill populations. When given by feeding tube, EN may be administered either continuously or intermittently. It is unclear which approach is superior in reducing gastrointestinal complications–such as diarrhoea–and meeting nutritional targets. The main objectives of this systematic review and meta-analysis are to 1) determine whether continuous or intermittent enteral nutrition is associated with higher incidence of adverse gastrointestinal outcomes, including diarrhoea; and 2) determine which feeding modality is associated in reaching nutritional goals. Methods and analysis: This systematic review protocol is reported in accordance with guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement. We will search Medline, Embase, The Cochrane Library, and the WHO ICTRP Search Portal for studies comparing continuous EN and intermittent EN in critically ill patients with no date or language restrictions. Studies will be screened, selected, and extracted independently and in duplicate. We will assess risk of bias assessment using the Cochrane Collaboration’s RoB 2 tool. The primary outcome will include the incidence of diarrhoea; secondary outcomes include other adverse GI outcomes (nausea, vomiting, abdominal pain, and constipation), as well as reaching nutritional goals, and length of ICU and hospital stay and mortality. We will pool data using a random effects model and assess certainty of evidence for each outcome using GRADE methodology. Ethics and dissemination: Ethics approval is not required for this study as no original data will be collected. We will disseminate results through peer-reviewed publication and conference presentations. PROSPERO registration number: CRD42022330118 ARTICLE SUMMARY Strengths and limitations of this study: