Comparison of Continuous and Intermittent Bolus Enteral Nutrition in Patients with Severe Traumatic Brain Injury: A Randomized Controlled Trial

Agiel Fahlevie Choirunanda (Udayana University)
I Wayan Aryabiantara (Udayana University)
Ida Bagus Krisna Jaya Sutawan (Udayana University)
I Gusti Putu Sukrana Sidemen (Udayana University)

Jurnal Anestesi dan Terapi Intensif Udayana
Vol. 2 No. 2 (2026): JATI AUGUST

Introduction: Severe traumatic brain injury (TBI) is associated with impaired gastric motility and dysregulated glucose homeostasis, making optimal enteral nutrition challenging. This study compared continuous and intermittent bolus enteral nutrition in terms of gastric residual volume (GRV), glycemic variability, and gastrointestinal tolerance in patients with severe TBI. Patients and Methods: An assessor-blinded, randomized controlled trial was conducted in 60 adult patients with severe TBI admitted to the intensive care unit. Participants were randomly assigned to continuous (n = 30) or intermittent bolus enteral nutrition (n = 30) during the first 24 hours after ICU admission. GRV was measured every 4 hours using gastric ultrasonography. Glycemic variability was assessed using the coefficient of variation (CV), and diarrhea was recorded as a marker of gastrointestinal tolerance. GRV was analyzed using repeatedmeasures analysis of variance (ANOVA), while glycemic fluctuation and diarrhea incidence were analyzed using Fisher’s exact and chi-square tests. Results: Sixty patients were analyzed, with comparable baseline characteristics between groups. Repeated-measures ANOVA demonstrated a significant overall effect of feeding method on GRV (F(1,58) = 158.235, p < 0.001) and a significant time × group interaction (Greenhouse–Geisser corrected F(3.980,230.814) = 3.437, p = 0.010). During the 24-hour observation period, continuous feeding resulted in a lower overall GRV than intermittent bolus feeding (mean difference 18.9 mL; 95% CI 15.9–21.9). Glycemic fluctuation was similar between groups (p = 0.500), whereas diarrhea occurred less frequently with continuous feeding (20.0% vs 50.0%, p = 0.008).  Conclusion: During the first 24 hours of ICU admission, continuous enteral nutrition was associated with lower overall GRV and a lower incidence of diarrhea than intermittent bolus feeding, while glycemic fluctuation was comparable between groups. Further studies are warranted to evaluate long-term clinical outcomes.