Impact of Not Measuring Residual Gastric Volume in Mechanically Ventilated Patients Receiving Early Enteral Feeding

Poulard, Fanny; Dimet, Jérôme; Martin-Lefèvre, Laurent; Bontemps, Fréderic; Fiancette, Maud; Clémenti, E.; Lebert, Christine; Renard, B.; Reignier, Jean

doi:10.1177/0148607109344745

Cited by 152 publications

(153 citation statements)

References 41 publications

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“…40,44,45 Some investigators [46][47][48][49] have suggested that the clinical utility of GRV measurements is limited. In a study 50 in 205 patients treated with mechanical ventilation who were receiving enteral nutrition, adverse events such as ventilator-associated pneumonia and vomiting did not differ between patients in whom GRV purposely was not measured and patients in whom GRV was measured. Current nutritional guidelines 25 suggest that enteral feedings should not be withheld if a patient has a GRV less than 500 mL and no other indications of feeding intolerance.…”

Section: Administration Of Enteral Nutrition and Pressure Ulcersmentioning

confidence: 93%

Enteral Nutrition in the Prevention and Treatment of Pressure Ulcers in Adult Critical Care Patients

Cox

Rasmussen

2014

Critical Care Nurse

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Section: Administration Of Enteral Nutrition and Pressure Ulcersmentioning

confidence: 93%

Enteral Nutrition in the Prevention and Treatment of Pressure Ulcers in Adult Critical Care Patients

Cox

Rasmussen

2014

Critical Care Nurse

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“…The rationale for measurement of GRVs is to reduce the risk for aspiration pneumonia by either ceasing or modifying the enteral feeding strategy based on the detection of excess gastric residuals. The inherent controversy is that observational and interventional studies have not consistently confirmed a relationship between the measurement of GRVs (with thresholds ranging from 200 mL to no monitoring of GRVs) and outcomes of vomiting, aspiration, or pneumonia [597][598][599][600][601][602][603]. In our systematic review, we identified one multicenter non-inferiority trial of 452 critically ill patients who were randomized to not monitoring GRVs versus monitoring GRVs at 6-h intervals [602].…”

Section: We Recommend Against the Use Of Omega-3 Fattymentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

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“…33,37 Specific determination of what constitutes a high GRV is unclear in the literature, and practices for assessing and addressing high GRVs vary. [38][39][40][41] Uncertainty regarding the assessment and treatment of high GRVs makes clinical decision making regarding management of GRVs difficult for practitioners.…”

Section: Intolerance Of Enteral Nutritionmentioning

confidence: 99%

“…20,38,40 In experimental studies, GRV did not correlate with aspiration, vomiting, or ventilator-associated pneumonia, 50,51 yet it continues to be standard to routinely monitor GRVs in practice. Measurement of GRV is subjective and is affected by the patient's position, the feeding tube diameter, the syringe size, and the clinician performing the measurement.…”

Section: Assessment Of and Response To Grvsmentioning

confidence: 99%

Interruptions in Enteral Nutrition Delivery in Critically Ill Patients and Recommendations for Clinical Practice

Stewart

2014

Critical Care Nurse

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M alnutrition results when nutritional intake does not meet metabolic requirements. Critically ill patients are at an increased risk for malnutrition because of alterations in protein and energy metabolism displayed in response to trauma, major surgery, burns, and sepsis 1 and may be unable to tolerate oral nutrition. Critical care nurses are well positioned to screen patients at risk for malnutrition and to work in conjunction with the multidisciplinary team to develop and implement interventions to prevent and treat malnutrition. Interruptions in Enteral Nutrition Delivery in Critically Ill Patients and Recommendations for Clinical Practice MELISSA L. STEWART, RN, DNP, MSN, CCNS, CCRNThis article has been designated for CNE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. List consequences of malnutrition in critically ill patients 2. Discuss how current nursing routines may contribute to interruptions in enteral nutrition in critically ill patients 3. Describe nursing interventions to improve the delivery of nutrition to critically ill patients CNE Continuing Nursing EducationCover Malnutrition is common in critically ill patients and is associated with poor outcomes for patients and increased health care spending. Enteral nutrition is the method of choice for nutrition delivery. Enteral nutrition delivery practices vary widely, and underfeeding is widespread in critical care. Interruptions in enteral nutrition due to performance of procedures, positioning, technical issues with feeding accesses, and gastrointestinal intolerance contribute to underfeeding. Strategies such as head-of-bed positioning, use of prokinetic agents, tolerance of higher gastric residual volumes, consideration of postpyloric feeding access, and use of a nutrition support protocol may decrease time spent without nutrition. (Critical Care Nurse.

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Impact of Not Measuring Residual Gastric Volume in Mechanically Ventilated Patients Receiving Early Enteral Feeding

Abstract: Early EN without RGV monitoring in mechanically ventilated patients improves the delivery of enteral feeding and may not increase vomiting or ventilator-associated pneumonia.

Cited by 152 publications

References 41 publications

Enteral Nutrition in the Prevention and Treatment of Pressure Ulcers in Adult Critical Care Patients

Enteral Nutrition in the Prevention and Treatment of Pressure Ulcers in Adult Critical Care Patients

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Interruptions in Enteral Nutrition Delivery in Critically Ill Patients and Recommendations for Clinical Practice

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