Effect of cyclic daytime versus continuous enteral nutrition on circadian rhythms in critical illness: a randomized controlled trial
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Objective
Circadian rhythms are frequently disrupted in patients in the intensive care unit (ICU), potentially worsening clinical outcomes. Continuous enteral nutrition throughout the day and night is common in the ICU, but eliminates feeding-fasting cycles that serve as important timing cues for the circadian system. The objective of this study was to determine the effect of providing enteral nutrition in a cyclic daytime pattern, compared with continuous administration, on circadian rhythmicity in critically ill patients in the ICU.
Design
Single-center randomized controlled trial
Setting
Mixed medical-surgical tertiary intensive care unit in the Netherlands
Patients
Adult ICU patients (≥18 yr) receiving enteral nutrition.
Intervention
Patients were randomized to receive either continuous, or cyclic daytime enteral feeding (08:00-20:00), initiated from the start of nutritional support.
Measurements and Main Results
Sixty-two ICU patients were enrolled, of whom 51 were included in the per-protocol analysis. While the amplitude of the 24-hour rhythm in core body temperature did not differ significantly between the cyclic daytime and continuous feeding groups (0.17 [interquartile range: 0.09-0.24] vs. 0.20 [0.13-0.30], p=0.182), the 24-hour rhythm in heart rate was enhanced in patients receiving cyclic daytime feeding, as reflected by significantly higher amplitudes and more synchronized peak times. No significant differences in 24-hour rhythmicity were observed between groups for the other vital signs or melatonin.
Conclusions
Our findings suggest that cyclic daytime feeding may strengthen circadian rhythms in critically ill patients. Further studies are warranted to evaluate its impact on clinical outcomes.
Trial registration
Registered at ClinicalTrials.gov (number: NCT05795881 ).
Key points
Question
Does cyclic daytime feeding – restricting enteral nutrition to daytime hours - enhance circadian rhythmicity in vital signs in critically ill patients, compared to standard continuous enteral nutrition?
Findings
In this randomized controlled trial of 62 ICU patients, the amplitude of the 24-hour in core body temperature did not differ significantly between the cyclic daytime and continuous feeding groups. However, the 24-hour rhythm in heart rate was enhanced in patients receiving cyclic daytime feeding, as reflected by significantly higher amplitudes and more synchronized peak times. No significant differences in 24-hour rhythmicity were observed between groups for the other vital signs or melatonin.
Meaning:
Our findings suggest that cyclic daytime feeding holds promise as a practical intervention to strengthen circadian rhythms in ICU patients, although further research is needed to determine whether it may affect other circadian outcomes or clinical outcomes.
