Is Gastric Residual Volume Measurement Really Necessary to Achieve Targeted Calories?

Alparslan Koç

doi:10.5152/EurJTher.2022.22043

Authors

Alparslan Koç Department of Anesthesiology and Reanimation, Erzincan Binali Yıldırım University Mengücek Gazi Training and Research Hospital, Erzincan, Turkey https://orcid.org/0000-0002-5965-9761

DOI:

https://doi.org/10.5152/EurJTher.2022.22043

Keywords:

Enteral nutrition, gastric residual volume, intensive care unit, malnutrition, target calorie

Abstract

Objective: Malnutrition, energy protein, and inadequate or excessive intake of other nutrients have measurable effects on tissues, body function, and clinical outcomes of patients. We aimed to determine the time to reach target calories, nutritional failures, and complications during feeding in measured and unmeasured gastric residual volume patients under ventilation in the intensive care unit.

Methods: The study was completed with 62 patients under mechanical ventilatory support in the intensive care unit. According to the consultation order, patients were divided into 2 groups. Gastric residual volume was measured in the control group (gastric residual volume, n=31) and not in the other (non-gastric residual volume, n=31). Nutrition nurses continuously monitored all enteral-fed patients, and the results were recorded.

Results: The feeding pause of the gastric residual volume group was longer than that of the non-gastric residual volume group (P < .001). The time to reach target calories was higher in the gastric residual volume group than in the non-gastric residual volume group (P=.010). The rate of vomiting as a complication was 9.7% (3 patients) in the gastric residual volume group and 6.5% in the non-gastric residual volume group, although the difference was not significant (P=.641). The observation rate of abdominal distension was 6.5% (2 patients) in the gastric residual volume group and the non-gastric residual volume group (P=.999). The positive end-expiratory pressure (PEEP) values were higher in patients who vomited, but the difference was not significant (P=.203). In patients with abdominal distension, PEEP values were higher than in patients without distension, but the difference was not significant (P=.282).

Conclusion: In conclusion, gastric residual volume measurement in patients with mechanical ventilatory support prolonged nutritional breaks and extended the time required to reach target calories compared with patients without gastric residual volume measurement

Metrics

Metrics Loading ...

References

Marik PE. Enteral nutrition in the critically ill: myths and misconceptions. Crit Care Med. 2014;42(4):962-969.

Kıter S, Atalay H, Özateş D, Serin S, Sungurtekin H. Evaluation of feeding interruption for enteral nutrition in intensive care unit patients. Cli Sci Nutr. 2019;1(2):103-109.

Patel JJ, Hurt RT, McClave SA, Martindale RG. Critical care nutrition: where's the evidence? Crit Care Clin. 2017;33(2):397-412.

Lew CCH, Wong GJY, Cheung KP, Chua AP, Chong MFF, Miller M. Association between malnutrition and 28-day mortality and intensive care length-of-stay in the critically ill: a prospective cohort study. Nutrients. 2017;10(1).

Kondrup J, Rasmussen HH, Hamberg O. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clinical Nutrition. 2003;22(3):321-336.

Hersberger L, Bargetzi L, Bargetzi A, et al. Nutritional risk screening (NRS 2002) is a strong and modifiable predictor risk score for short-term and long-term clinical outcomes: secondary analysis of a prospective randomised trial. Clin Nutr. 2020;39(9):2720-2729.

Heyland D, Cook DJ, Winder B, Brylowski L, Van deMark H, Guyatt G. Enteral nutrition in the critically ill patient: a prospective survey. Crit Care Med. 1995;23(6):1055-1060.

Elke G, Felbinger TW, Heyland DK. Gastric residual volume in critically ill patients: a dead marker or still alive? Nutr Clin Pract. 2015;30(1):59-71.

Adam S, Batson S. A study of problems associated with the delivery of enteral feed in critically ill patients in five ICUs in the UK. Intensive Care Med. 1997;23(3):261-266.

McClave SA, Sexton LK, Spain DA, et al. Enteral tube feeding in the intensive care unit: factors impeding adequate delivery. Crit Care Med. 1999;27(7):1252-1256.

Bartlett Ellis RJ, Fuehne J. Examination of accuracy in the assessment of gastric residual volume: a simulated, controlled study. JPEN J Parenter Enteral Nutr. 2015;39(4):434-440.

Rice TW. Gastric residual volume: end of an era. JAMA. 2013;309(3):283-284.

El-Ganzoury MM, El-Farrash RA, Ahmed GF, Hassan SI, Barakat NM. Perioperative nutritional prehabilitation in malnourished children with congenital heart disease: a randomized controlled trial. Nutrition. 2021;84:111027.

Bankhead R, Boullata J, Brantley S, et al. A.S.P.E.N. JPEN J Parenter Enteral Nutr. 2009;33(2):122-167.

Metheny NA, Stewart J, Nuetzel G, Oliver D, Clouse RE. Effect of feeding-tube properties on residual volume measurements in tube-fed patients. JPEN J Parenter Enter Nutr. 2005;29(3):192-197.

McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2009;33(3):277-316.

Guidelines CCP. Strategies to optimize the delivery of EN: Use of and threshold for gastric residual. https ://ww w.cri tical caren utrit ion. c om/do cs/CP Gs%20 2015/ 5.5%2 02015 .pdf

Metheny NA, Mills AC, Stewart BJ. Monitoring for intolerance to gastric tube feedings: a national survey. Am J Crit Care. 2012;21(2):e33-e40.

McClave SA, Lukan JK, Stefater JA, et al. Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Crit Care Med. 2005;33(2):324-330.

Montejo JC, Miñambres E, Bordejé L, et al. Gastric residual volume during enteral nutrition in ICU patients: the REGANE study. Intensive Care Med. 2010;36(8):1386-1393.

Mentec H, Dupont H, Bocchetti M, Cani P, Ponche F, Bleichner G. Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Crit Care Med. 2001;29(10):1955-1961.

Marvin RG, McKinley BA, McQuiggan M, Cocanour CS, Moore FA. Nonocclusive bowel necrosis occurring in critically ill trauma patients receiving enteral nutrition manifests no reliable clinical signs for early detection. Am J Surg. 2000;179(1):7-12.

Akinci IO, Çakar N, Mutlu GM, et al. Gastric intramucosal pH is stable during titration of positive end-expiratory pressure to improve oxygenation in acute respiratory distress syndrome. Crit Care. 2003;7(3):R17-R23.

Edwards SJ, Metheny NA. Measurement of gastric residual volume: state of the science. Medsurg Nurs. 2000;9(3):125-128.

Wiese AN, Rogers MJM, Way M, Ballard E. The impact of removing gastric residual volume monitoring and enteral nutrition rate titration in adults receiving mechanical ventilation. Aust Crit Care. 2020;33(2):155-161.

Wang Z, Ding W, Fang Q, Zhang L, Liu X, Tang Z. Effects of not monitoring gastric residual volume in intensive care patients: a metaanalysis. Int J Nurs Stud. 2019;91:86-93.

Bouvet L, Zieleskiewicz L, Loubradou E, et al. Reliability of gastric suctioning compared with ultrasound assessment of residual gastric volume: a prospective multicentre cohort study. Anaesthesia. 2020;75(3):323-330.

Kaçmaz M, Şahİn Kocaöz F, Destegül D, Yüksel Turhan Z, Bayraktar M. The relationship of gastrointestinal complications and ventilator related status with gastric residual volume in intensive care patients. Acta Med Alanya. 2021;5(2):157-163.