{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T08:58:53Z","timestamp":1765011533911,"version":"3.46.0"},"reference-count":30,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Groupement Interr\u00e9gional de Recherche Clinique et d\u2019Innovation of North-West France"},{"name":"French Ministry of Health"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,6,26]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Critically ill patients often require enteral nutrition, but the optimal feeding strategy\u2014continuous or intermittent\u2014remains uncertain. While continuous enteral nutrition ensures steady nutrient delivery, it may inhibit key metabolic and cellular processes such as autophagy and ketogenesis. Intermittent enteral nutrition, by mimicking fasting periods, could activate protective pathways, potentially improving clinical outcomes. However, evidence for its efficacy and safety in intensive care units (ICUs) is limited. This study evaluates the clinical and metabolic impacts of fasting intervals during intermittent enteral nutrition compared with continuous enteral nutrition in critically ill patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      We designed a multicenter, randomised, open-label trial across nine French ICUs, enrolling adult patients requiring mechanical ventilation and vasopressor support. Participants will receive either intermittent or continuous enteral nutrition for 7 days, with the primary endpoint being the change in the Sequential Organ Failure Assessment (SOFA) score from Day 1 to Day 7 or ICU discharge. Secondary endpoints include nutritional intake, metabolic markers, gastrointestinal tolerance, ICU-acquired infections and mortality rates. Quality of life will be assessed at discharge. A total of 174 patients will be included. Descriptive statistics will summarise group characteristics, with the Student\u2019s t-test or the Mann-Whitney U test depending on data distribution for SOFA score change, and regression for confounders. Secondary endpoints will be analysed using regression, \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      or Fisher\u2019s exact test, as appropriate.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study protocol was approved by a French ethics committee on 24 October 2023 (Comit\u00e9 de Protection des Personnes Ile de France 1, Paris, France, number SI 23.03427.000435). Patients are included after providing informed consent. Results will be submitted for publication in a peer-reviewed journal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      Registered on clinicaltrials.gov on 26 March 2023 (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06330610\">NCT06330610<\/jats:ext-link>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-099761","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T09:00:23Z","timestamp":1754038823000},"page":"e099761","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and metabolic phenotyping of continuous versus intermittent ENteral NUTrition in ventilated adults with shock: ENNUT trial protocol"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct06330610","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Abdellah","family":"Tebani","sequence":"first","affiliation":[{"name":"Department of Metabolic Biochemistry, University Hospital Centre Rouen, Rouen, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9768-0193","authenticated-orcid":false,"given":"Zo\u00e9","family":"Demailly","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Intensive R\u00e9animation, University Hospital Centre Rouen, Rouen, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soumeya","family":"Bekri","sequence":"additional","affiliation":[{"name":"Department of Metabolic Biochemistry, University Hospital Centre Rouen, Rouen, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julien","family":"Maizel","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Intensive R\u00e9animation, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antoine","family":"Marchalot","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Intensive R\u00e9animation, Centre Hospitalier de Dieppe, Dieppe, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claire","family":"Bourel","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Intensive R\u00e9animation, Centre Hospitalier Universitaire de Lille, Lille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Damien","family":"Du Cheyron","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Intensive R\u00e9animation, University Hospital Centre Caen, Caen, 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