Effect of Intermittent or Continuous Feed on Muscle Wasting in Critical Illness: A Phase 2 Clinical Trial

Angela S. McNelly; Danielle E. Bear; Bronwen A. Connolly; Gill Arbane; Laura Allum; Azhar Tarbhai; Jackie A. Cooper; Philip A. Hopkins; Matthew P. Wise; David Brealey; Kieron Rooney; Jason Cupitt; Bryan Carr; Kiran Koelfat; Steven Olde Damink; Philip J. Atherton; Nicholas Hart; Hugh E. Montgomery; Zudin A. Puthucheary

doi:10.1016/j.chest.2020.03.045

Effect of Intermittent or Continuous Feed on Muscle Wasting in Critical Illness: A Phase 2 Clinical Trial

Angela S. McNelly^*, Danielle E. Bear, Bronwen A. Connolly, Gill Arbane, Laura Allum, Azhar Tarbhai, Jackie A. Cooper, Philip A. Hopkins, Matthew P. Wise, David Brealey, Kieron Rooney, Jason Cupitt, Bryan Carr, Kiran Koelfat, Steven Olde Damink, Philip J. Atherton, Nicholas Hart, Hugh E. Montgomery, Zudin A. Puthucheary

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

54 Citations (Web of Science)

Abstract

BACKGROUND: Acute skeletal muscle wasting in critical illness is associated with excess morbidity and mortality. Continuous feeding may suppress muscle protein synthesis as a result of the muscle-full effect, unlike intermittent feeding, which may ameliorate it.

RESEARCH QUESTION: Does intermittent enteral feed decrease muscle wasting compared with continuous feed in critically ill patients?

STUDY DESIGN AND METHODS: In a phase 2 interventional single-blinded randomized controlled trial, 121 mechanically ventilated adult patients with multiorgan failure were recruited following prospective informed consultee assent. They were randomized to the intervention group (intermittent enteral feeding from six 4-hourly feeds per 24 h, n = 62) or control group (standard continuous enteral feeding, n = 59). The primary outcome was 10-day loss of rectus femoris muscle cross-sectional area determined by ultrasound. Secondary outcomes included nutritional target achievements, plasma amino acid concentrations, glycemic control, and physical function milestones.

RESULTS: Muscle loss was similar between arms (-1.1% [95% CI, -6.1% to -4.0%]; P =.676). More intermittently fed patients received 80% or more of target protein (OR, 1.52 [1.16-1.99]; P

INTERPRETATION: Intermittent feeding in early critical illness is not shown to preserve muscle mass in this trial despite resulting in a greater achievement of nutritional targets than continuous feeding. However, it is feasible and safe.

Original language	English
Pages (from-to)	183-194
Number of pages	12
Journal	Chest
Volume	158
Issue number	1
DOIs	https://doi.org/10.1016/j.chest.2020.03.045
Publication status	Published - Jul 2020

Keywords

critical care
energy delivery
muscle wasting
nutrition
protein delivery
UNIT-ACQUIRED WEAKNESS
HUMAN SKELETAL-MUSCLE
ILL PATIENTS
ENTERAL NUTRITION
PROTEIN-SYNTHESIS
CARE
THERAPY
TIME
REHABILITATION
SURVIVORS

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McNelly, A. S., Bear, D. E., Connolly, B. A., Arbane, G., Allum, L., Tarbhai, A., Cooper, J. A., Hopkins, P. A., Wise, M. P., Brealey, D., Rooney, K., Cupitt, J., Carr, B., Koelfat, K., Damink, S. O., Atherton, P. J., Hart, N., Montgomery, H. E., & Puthucheary, Z. A. (2020). Effect of Intermittent or Continuous Feed on Muscle Wasting in Critical Illness: A Phase 2 Clinical Trial. Chest, 158(1), 183-194. https://doi.org/10.1016/j.chest.2020.03.045

@article{2ebc5884f37d44719fb11ad400bf9467,

title = "Effect of Intermittent or Continuous Feed on Muscle Wasting in Critical Illness: A Phase 2 Clinical Trial",

abstract = "BACKGROUND: Acute skeletal muscle wasting in critical illness is associated with excess morbidity and mortality. Continuous feeding may suppress muscle protein synthesis as a result of the muscle-full effect, unlike intermittent feeding, which may ameliorate it.RESEARCH QUESTION: Does intermittent enteral feed decrease muscle wasting compared with continuous feed in critically ill patients?STUDY DESIGN AND METHODS: In a phase 2 interventional single-blinded randomized controlled trial, 121 mechanically ventilated adult patients with multiorgan failure were recruited following prospective informed consultee assent. They were randomized to the intervention group (intermittent enteral feeding from six 4-hourly feeds per 24 h, n = 62) or control group (standard continuous enteral feeding, n = 59). The primary outcome was 10-day loss of rectus femoris muscle cross-sectional area determined by ultrasound. Secondary outcomes included nutritional target achievements, plasma amino acid concentrations, glycemic control, and physical function milestones.RESULTS: Muscle loss was similar between arms (-1.1% [95% CI, -6.1% to -4.0%]; P =.676). More intermittently fed patients received 80% or more of target protein (OR, 1.52 [1.16-1.99]; PINTERPRETATION: Intermittent feeding in early critical illness is not shown to preserve muscle mass in this trial despite resulting in a greater achievement of nutritional targets than continuous feeding. However, it is feasible and safe.",

keywords = "critical care, energy delivery, muscle wasting, nutrition, protein delivery, UNIT-ACQUIRED WEAKNESS, HUMAN SKELETAL-MUSCLE, ILL PATIENTS, ENTERAL NUTRITION, PROTEIN-SYNTHESIS, CARE, THERAPY, TIME, REHABILITATION, SURVIVORS",

author = "McNelly, {Angela S.} and Bear, {Danielle E.} and Connolly, {Bronwen A.} and Gill Arbane and Laura Allum and Azhar Tarbhai and Cooper, {Jackie A.} and Hopkins, {Philip A.} and Wise, {Matthew P.} and David Brealey and Kieron Rooney and Jason Cupitt and Bryan Carr and Kiran Koelfat and Damink, {Steven Olde} and Atherton, {Philip J.} and Nicholas Hart and Montgomery, {Hugh E.} and Puthucheary, {Zudin A.}",

year = "2020",

month = jul,

doi = "10.1016/j.chest.2020.03.045",

language = "English",

volume = "158",

pages = "183--194",

journal = "Chest",

issn = "0012-3692",

publisher = "Elsevier",

number = "1",

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McNelly, AS, Bear, DE, Connolly, BA, Arbane, G, Allum, L, Tarbhai, A, Cooper, JA, Hopkins, PA, Wise, MP, Brealey, D, Rooney, K, Cupitt, J, Carr, B, Koelfat, K , Damink, SO, Atherton, PJ, Hart, N, Montgomery, HE & Puthucheary, ZA 2020, 'Effect of Intermittent or Continuous Feed on Muscle Wasting in Critical Illness: A Phase 2 Clinical Trial', Chest, vol. 158, no. 1, pp. 183-194. https://doi.org/10.1016/j.chest.2020.03.045

TY - JOUR

T1 - Effect of Intermittent or Continuous Feed on Muscle Wasting in Critical Illness

T2 - A Phase 2 Clinical Trial

AU - McNelly, Angela S.

AU - Bear, Danielle E.

AU - Connolly, Bronwen A.

AU - Arbane, Gill

AU - Allum, Laura

AU - Tarbhai, Azhar

AU - Cooper, Jackie A.

AU - Hopkins, Philip A.

AU - Wise, Matthew P.

AU - Brealey, David

AU - Rooney, Kieron

AU - Cupitt, Jason

AU - Carr, Bryan

AU - Koelfat, Kiran

AU - Damink, Steven Olde

AU - Atherton, Philip J.

AU - Hart, Nicholas

AU - Montgomery, Hugh E.

AU - Puthucheary, Zudin A.

PY - 2020/7

Y1 - 2020/7

N2 - BACKGROUND: Acute skeletal muscle wasting in critical illness is associated with excess morbidity and mortality. Continuous feeding may suppress muscle protein synthesis as a result of the muscle-full effect, unlike intermittent feeding, which may ameliorate it.RESEARCH QUESTION: Does intermittent enteral feed decrease muscle wasting compared with continuous feed in critically ill patients?STUDY DESIGN AND METHODS: In a phase 2 interventional single-blinded randomized controlled trial, 121 mechanically ventilated adult patients with multiorgan failure were recruited following prospective informed consultee assent. They were randomized to the intervention group (intermittent enteral feeding from six 4-hourly feeds per 24 h, n = 62) or control group (standard continuous enteral feeding, n = 59). The primary outcome was 10-day loss of rectus femoris muscle cross-sectional area determined by ultrasound. Secondary outcomes included nutritional target achievements, plasma amino acid concentrations, glycemic control, and physical function milestones.RESULTS: Muscle loss was similar between arms (-1.1% [95% CI, -6.1% to -4.0%]; P =.676). More intermittently fed patients received 80% or more of target protein (OR, 1.52 [1.16-1.99]; PINTERPRETATION: Intermittent feeding in early critical illness is not shown to preserve muscle mass in this trial despite resulting in a greater achievement of nutritional targets than continuous feeding. However, it is feasible and safe.

AB - BACKGROUND: Acute skeletal muscle wasting in critical illness is associated with excess morbidity and mortality. Continuous feeding may suppress muscle protein synthesis as a result of the muscle-full effect, unlike intermittent feeding, which may ameliorate it.RESEARCH QUESTION: Does intermittent enteral feed decrease muscle wasting compared with continuous feed in critically ill patients?STUDY DESIGN AND METHODS: In a phase 2 interventional single-blinded randomized controlled trial, 121 mechanically ventilated adult patients with multiorgan failure were recruited following prospective informed consultee assent. They were randomized to the intervention group (intermittent enteral feeding from six 4-hourly feeds per 24 h, n = 62) or control group (standard continuous enteral feeding, n = 59). The primary outcome was 10-day loss of rectus femoris muscle cross-sectional area determined by ultrasound. Secondary outcomes included nutritional target achievements, plasma amino acid concentrations, glycemic control, and physical function milestones.RESULTS: Muscle loss was similar between arms (-1.1% [95% CI, -6.1% to -4.0%]; P =.676). More intermittently fed patients received 80% or more of target protein (OR, 1.52 [1.16-1.99]; PINTERPRETATION: Intermittent feeding in early critical illness is not shown to preserve muscle mass in this trial despite resulting in a greater achievement of nutritional targets than continuous feeding. However, it is feasible and safe.

KW - critical care

KW - energy delivery

KW - muscle wasting

KW - nutrition

KW - protein delivery

KW - UNIT-ACQUIRED WEAKNESS

KW - HUMAN SKELETAL-MUSCLE

KW - ILL PATIENTS

KW - ENTERAL NUTRITION

KW - PROTEIN-SYNTHESIS

KW - CARE

KW - THERAPY

KW - TIME

KW - REHABILITATION

KW - SURVIVORS

U2 - 10.1016/j.chest.2020.03.045

DO - 10.1016/j.chest.2020.03.045

M3 - Article

C2 - 32247714

SN - 0012-3692

VL - 158

SP - 183

EP - 194

JO - Chest

JF - Chest

IS - 1

ER -