INTERMITTENT ENTERAL FEEDING - THE INFLUENCE ON RESPIRATORY AND DIGESTIVE-TRACT COLONIZATION IN MECHANICALLY VENTILATED INTENSIVE-CARE-UNITPATIENTS

Continuous enteral feeding (CEF) has been associated with decreased ga stric acidity, thereby stimulating gastric colonization and ventilator -associated pneumonia (VAP). Intermittent enteral feeding (IEF) could induce a temporary increase in gastric acidity and decrease the risk o f VAP. We studied the influence of IEF (18 h/d) and CEF (24 h/d) on ga stric and oropharyngeal colonization. Sixty patients were randomized t o receive either IEF or CEF, and continuous intragastric pH monitoring was performed in 50 patients. Median intragastric pH levels were simi lar before enteral feeding was instituted (pH 2.5 for CEF and pH 2.4 f or IEF), and median pH values increased slightly after institution of nutrition (NS). In patients receiving IEF, median pH decreased from 3. 5 to 2.2 (p = 0.0002) when enteral feeding was discontinued. However, despite this, 80% of the patients in both study groups were colonized in the stomach after 7 d in study. In addition, colonization rates of the oropharynx and trachea, the incidence of VAP, and mortality were s imilar in both study groups. IEF was less well tolerated than CEF. We conclude that almost all patients receiving enteral feeding are coloni zed in the stomach with gram-negative bacteria. IEF resulted in a slig ht decrease in intragastric pH without influencing rates of colonizati on and infection of the respiratory tract.