The Comparison of Continuous and Intermittent Enteral Nutrition In Cerebrovascular Patients

OBJECTIVE: Dysphagia and malnutrition are not so rare in stroke patients, and have an unfavorable influence on recovery. Nutritional support may reduce infections, duration of hospital stay and mortality. However, there is no clear evidence about the modality of nasogastric nutrition. In this study, intermittent and continuous enteral nutrition is compared by means of pulmonary infections and gastrointestinal tolerance, among acute cerebrovascular patients. METHODS: Sixty two acute cerebrovascular patients with dysphagia were included the study. The same volume of nutrition product was infused 4 times daily to 31 patients, and continuously for 24 hours to the remaining 31. After 10 days of follow-up, the rates of pulmonary infections, diarrhea, increased gastric residual volumes, vomiting and tube occlusion were compared between two groups. RESULTS: Twenty patients developed pneumonia (32%) and 8 diarrhea (13%). Mortality due to complications associated with tube feeding was 6%. Aspiration and related pneumonia was present in 11 patients in the intermittent nutrition group (35%), and in 9 patients in the continuous nutrition group (29%). The rate of pulmonary infection was not statistically different between two groups (p>0.05). Diarrhea was observed in 7 intermittently fed patients (23%), while was present only in 1 patient (3%) in the continuously fed group. Diarrhea was more common in the intermittent nutrition group, just at the statistical border (p=0.05). None of the patients developed tube occlusion, vomiting and gastric retention. The rate of mortality and the interruption of feeding was not significantly different between two groups (p>0.05). CONCLUSION: Diarrhea and pulmonary infections are more prevalent with intermittent tube feeding with respect to continuous enteral nutrition, though the difference is not so conspicuous. The reason may be contamination of the equipments and the feeding solution because of frequent manipulation and interruption of infusion. Continuous infusion should be preferred for the acute stroke patient requiring nasogastric feedin