Current practice of gastric residual volume measurements and related outcomes of critically ill patients: A secondary analysis of the intestinal‐specific organ function assessment  study

Abstract

Background Gastric residual volume (GRV) measurement to detect gastrointestinal (GI) dysfunction is a common diagnostic procedures in critical care, albeit still not well standardized being operator‐, patient‐, and tube‐dependent. Our aim was to describe current practice of GRV measurements and its association with clinical outcomes in critically ill patients. Methods This was a secondary analysis of an international prospective observational cohort study (intestinal‐specific organ function assessment). Eligibility criteria were defined as ≥1 GRV measurement during the 7‐day study period. Data collection included GRV measurement practices, tube diameters and volumes, symptoms of GI dysfunction, and clinical outcomes. The primary aim was to describe current practices of GRV measurements, and the secondary aim was to test the association of high (>200 ml) vs. low GRV with symptoms of GI dysfunction and clinical outcomes using generalized linear regression and survival models. Results Two hundred fifty‐eight patients with 2422 GRV measurements on 875 study days were analyzed. GRV was mainly measured via passive drainage twice daily using large diameter tubes. There was no significant association between tube size or measurement technique and high GRV. High GRV occurred in 34% of patients and was associated with other GI symptoms and with increased disease severity but not with 28‐day or 90‐day mortality, intensive care unit‐free and ventilator‐free days. Conclusion There was substantial variability of GRV measurement techniques, but this had no impact on the amount of GRV. High GRV was not associated with mortality or ventilator‐free days but may serve as a marker of GI dysfunction and disease severity.

Nutritional management during critical illness in those with previous obesity surgery

“…Nonetheless, there is no rationale for measuring the gastric residual volume, which should follow the institution's protocols. Measurement of the gastric residue volume should not be routine but should be selected for the patient under suspicion of gastrointestinal dysfunction [25].…”