Adoption of continuous feeding protocol to intermittent bolus enteral feeding as an alternative Dr.Subasini T, Dr.Tejokali Kapalli, Dr.Manimala Rao S. Department of Anaesthesiology and Intensive care, The Nizam's Institute of Medical Sciences, Hyderabad. Andhra Pradesh, India. Background - Nutritional support is a respected speciality. The advantages of early enteral nutrition are well known. Nasogastric route is most commonly used for enteral feeding. Feeds can be administered either as continuous infusions or as intermittent boluses. Intermittent bolus administration is simple, but could be associated with problems. In advanced intensive care units continuous feeding technique is routinely used to prevent gastrointestinal intolerance (as evidenced by large nasogastric aspirates and diarrhoea) and minimize the risk of aspiration. This requires an enteral infusion device (feeding pump) to enhance the safety and accuracy. Various protocols are available for continuous enteral feeding. Due to the non availability of the feeding pumps in our Institute, we have adopted the continuous feeding protocol to modified intermittent bolus method as an alternative. Aim - To evaluate the feasibility of adopting the continuous feeding protocol to modified intermittent bolus feeding. Material And Methods - The modified bolus intermittent feeding protocol was adopted since January 2003 in our Intensive Care Unit. From January 2003 to June 2003, 76 Patients fed enterally via the nasogastric tubes using the protocol were evaluated. All these patients required mechanical ventilatory support following Organocompound poisoning (n =12), surgery (n =15), sepsis (n =25), trauma (n =10), respiratory failure consequent to COAD & neurological disorders (n =14). The calculated feeds were prepared using commercial enteral feed powders & mineral water in a feeding bag using non touch technique. These were administered every 2hours. Nasogastric (NG) aspiration was done every 4hours.Prokinetic (Metoclopramide) was given as necessary. The feasibility of administering bolus feeds adopting the continuous feeding protocol is evaluated estimating the incidence of gastric intolerance as evidenced by larfe NG aspirates & diarrhoea; emesis / regurgitation. The number of patients (non diabetic) requiring insulin therapy to maintain normal blood sugar were noted as it is said that bolus feeds are associated with less hyperglycaemia as compared to continuous feeds. Results - A total of 76 patients received NG feeds as per the adopted. Large NG aspirates were seen in 10 patients (13.15%), diarrhoea in 8 patients (10.5%), regurgitation of the feeds in 5 patients (6.5%), and insulin therapy was required In 10 patients (13.5%), supplemental TPN was required in 9 patients (11.84%). Conclusions - Protocol based continuous enteral feeding is a well established technique in most advanced ICUs. Adoption of this protocol to modified intermittent bolus feeding could be a valid alternative in centers where feeding pumps are not available. Bolus intermittent feeds are advantageous in terms of being easier to administer, better blood sugar control, smaller gall bladder sizes, more physiological as humans are meant to be meal eaters and are not well adapted to continuous infusion of nutrients. However a large controlled randomized trial is necessary. From "PENSA 2003" Cidade de Goa, India, November 6-8, 2003 Page : 143