Doctors in intensive care units need to feed patients who can’t eat normally, so they use feeding tubes. There are two main ways to do this: feeding continuously all day long, or giving meals in four separate doses throughout the day. Researchers wanted to know which method is safer and works better. They studied 40 critically ill patients and found that both methods worked equally well at getting patients the nutrition they needed. The method using separate meals had fewer interruptions, which might help patients get better nutrition overall. Both methods were safe with similar rates of side effects like vomiting and diarrhea.

The Quick Take

  • What they studied: Whether giving nutrition through a feeding tube continuously (like a slow drip all day) is safer and more effective than giving it in four separate meals spaced throughout the day for patients in the intensive care unit.
  • Who participated: 40 adult patients in the ICU who needed feeding tubes. Most were men (70%), averaging about 63 years old. They were very sick patients on breathing machines. About 18 received continuous feeding and 22 received feeding in separate doses.
  • Key finding: Both feeding methods worked equally well. About 89% of the continuous group and 77% of the separate-dose group reached their nutrition goals (not a meaningful difference). Both groups had similar rates of stomach problems like vomiting and diarrhea. The separate-dose method had fewer interruptions in feeding.
  • What it means for you: If you or a loved one needs a feeding tube in the ICU, doctors can feel confident using either method. The separate-dose approach might be slightly better because it had fewer interruptions, but more research with more patients is needed to be certain.

The Research Details

This was a randomized controlled trial, which is one of the strongest types of medical research. Researchers divided 40 ICU patients into two groups randomly (like flipping a coin). One group received nutrition continuously through a pump all day long, while the other group received the same total amount of nutrition divided into four separate meals given over one hour each, spaced six hours apart. Both groups used feeding tubes placed in the stomach. The researchers tracked what happened to each patient, including whether they got enough calories, if they had stomach problems, breathing problems, or other complications.

This research design is important because it helps doctors figure out the best way to feed very sick patients. When patients are randomly assigned to different groups, it reduces bias and helps prove which method actually works better. By comparing the two methods directly in the same hospital setting, researchers could see real differences in safety and effectiveness.

The study was approved by an ethics committee, which is important for patient safety. The researchers used standard statistical methods to analyze their data. However, the study is relatively small with only 40 patients, which means the results might not apply to all ICU patients. The two groups were similar in most ways, though the continuous feeding group was slightly sicker on average. The researchers used an ‘intention-to-treat’ analysis, which is a gold-standard approach that counts all patients in their original groups, even if they didn’t complete the study as planned.

What the Results Show

The main finding was that both feeding methods worked similarly well. In the continuous feeding group, 88.9% of patients reached their nutrition goals, while 77.3% in the separate-dose group did so—this difference was not statistically significant, meaning it could have happened by chance. Both groups took about the same time to reach their nutrition goals (36 hours for continuous versus 34 hours for separate doses). Vomiting occurred in 20% of patients overall, with equal numbers in each group (4 patients per group). Diarrhea happened in 16.7% of the continuous group and 22.7% of the separate-dose group, again showing no meaningful difference. Serious complications like food going into the lungs occurred in only one patient, who was in the separate-dose group.

An important secondary finding was that the separate-dose feeding method had significantly fewer interruptions (median of 1 interruption versus 2.5 in the continuous group). This suggests that the separate-dose approach might be easier to maintain without stopping and starting. Both groups had similar rates of achieving their caloric goals despite these differences in interruptions. The study found no differences in metabolic complications between the two groups, meaning blood sugar and other chemical balances were handled similarly well by both methods.

The researchers noted that their results are similar to what other studies have found. Previous research has shown mixed results about which feeding method is better, with some studies suggesting one method might have advantages. This study adds to that body of evidence by showing that in terms of safety and effectiveness, both methods appear comparable. The finding about fewer interruptions with separate-dose feeding is particularly interesting because it suggests a practical advantage that hadn’t been as clearly demonstrated before.

The biggest limitation is the small sample size of only 40 patients. With more patients, researchers might have found differences that weren’t visible in this smaller group. The study was open-label, meaning both doctors and patients knew which feeding method was being used, which could potentially influence results. The continuous feeding group was slightly sicker on average at the start, which might have affected outcomes. The study only looked at patients with feeding tubes in the stomach, so results might not apply to other types of feeding tubes. Finally, the study was conducted at one hospital, so results might differ in other settings.

The Bottom Line

Based on this research, both continuous and separate-dose feeding methods appear safe and effective for ICU patients with feeding tubes. The separate-dose method may have a slight advantage due to fewer interruptions, but the difference is not dramatic enough to strongly recommend one over the other. Doctors should consider patient-specific factors, hospital resources, and nursing preferences when choosing a method. More research with larger groups of patients is needed before making strong recommendations. Confidence level: Moderate—this is good evidence but from a small study.

This research matters most for ICU doctors, nurses, and nutritionists who care for critically ill patients. It’s relevant for patients and families facing decisions about feeding tube methods during critical illness. It may be less relevant for patients receiving nutrition support outside the ICU setting, as results might differ. People with diabetes should know this study included some diabetic patients, though the numbers were small.

In this study, patients reached their nutrition goals within about 34-36 hours regardless of feeding method. Benefits in terms of better nutrition and fewer complications would likely be seen within the first few days of ICU admission. However, the full impact on patient recovery might take weeks to become apparent, as nutrition is just one part of ICU care.

Want to Apply This Research?

  • If tracking ICU nutrition support, record daily caloric intake achieved (as a percentage of goal), number of feeding interruptions, and any gastrointestinal symptoms (vomiting, diarrhea). Track which feeding method is being used and compare actual calories delivered versus planned calories.
  • For healthcare providers using an app: Set reminders to monitor feeding tube placement and function every 6 hours. Log any interruptions immediately with the reason (clogged tube, patient movement, etc.). Track time to reach caloric goals as a quality metric. For patients/families: Use the app to understand which feeding method your care team chose and why, and to track any side effects to discuss with doctors.
  • Establish a daily tracking system that records: (1) total calories delivered versus calories prescribed, (2) number and duration of feeding interruptions, (3) any gastrointestinal symptoms, and (4) patient tolerance of the feeding method. Review this data weekly with the nutrition team to optimize feeding approach. Compare trends over time to see if one method maintains better consistency in your specific patient population.

This research summary is for educational purposes only and should not replace professional medical advice. Decisions about feeding tube methods for critically ill patients should be made by qualified healthcare providers based on individual patient needs, medical history, and hospital protocols. This study involved a small number of patients, and results may not apply to all ICU populations. Always consult with your medical team before making changes to nutrition support methods. If you have concerns about a patient’s feeding tube care or nutrition, discuss them immediately with the ICU care team.