Sonographic Evaluation of Gastric Residual Volume during Enteral Nutrition in Critically Ill Patients Using a Miniaturized Ultrasound Device

Abstract

Background: To assess the risk of aspiration, nutrient tolerance, and gastric emptying of patients in ICUs, gastric ultrasound can provide information about the gastric contents. Using established formulas, the gastric residual volume (GRV) can be calculated in a standardized way by measuring the gastric antrum. The purpose of this study was to determine the GRV in a cohort of enterally fed patients using a miniaturized ultrasound device to achieve knowledge about feasibility and the GRV over time during the ICU stay. The findings could contribute to the optimization of enteral nutrition (EN) therapy. Methods: A total of 217 ultrasound examinations with 3 measurements each (651 measurements in total) were performed twice daily (morning and evening) in a longitudinal observational study on 18 patients with EN in the interdisciplinary surgical ICU of Saarland University Medical Center. The measured values of the GRV were analyzed in relation to the clinical course, the nutrition, and other parameters. Results: Measurements could be performed without interrupting the flow of clinical care and without pausing EN. The GRV was significantly larger with sparsely auscultated bowel sounds than with normal and excited bowel sounds (p < 0.01). Furthermore, a significantly larger GRV was present when using a high-caloric/low-protein nutritional product compared to an isocaloric product (p = 0.02). The GRV at the morning and evening measurements showed no circadian rhythm. When comparing the first and last ultrasound examination of each patient, there was a tendency towards an increased GRV (p = 0.07). Conclusion: The GRV measured by miniaturized ultrasound devices can provide important information about ICU patients without restricting treatment procedures in the ICU. Measurements are possible while EN therapy is ongoing. Further studies are needed to establish gastric ultrasound as a management tool in nutrition therapy.

Gastric Cross-Sectional Area to Predict Gastric Intolerance in Critically Ill Patients: The Sono-ICU Prospective Observational Bicenter Study

“…We also found good intraoperative reliability with ICCs considered as “almost perfect agreement” ( 24 ). A recent study by Jahreis et al ( 17 ) and one by Bouvet et al ( 27 ) support our data in terms of feasibility (100% feasible GCSA measurements in 217 patients and 75 patients in the two studies, respectively). Furthermore, this examination is simple and can be rapidly learned (95% success rate after 33 measurements) ( 28 ), so the process could be transferred to paramedical teams.…”

“…Ultrasound measurement of the gastric cross-sectional area (GCSA), easily performed at the bedside, is a technique that has been developed in anesthesia, particularly in the preoperative period, to evaluate the gastric content before induction of an anesthetic ( 16 ). It has also been used in the ICU ( 17 ). The measurement of GCSA has been shown to correlate with the gastric volume whether measured by GRV ( 18 ) or by CT scan ( 19 ).…”

Effects of metoclopramide administration on gastric emptying in mechanically ventilated intensive care patients: A prospective randomized controlled trial

“…All patients were statistically analyzed and followed up with until the conclusion of the investigation. Figure (2) Demographic data were comparable among the both examined groups (p>0.05). (Table 1) Before EN beginning, the mean value (±SD) of APACHE II score was (13.65±2.05) and (13.45±2.34) in metoclopramide and control groups respectively.…”

“…Enteral nutrition (EN) is crucial in the critical care treatment, particularly when there is a decrease in nutritional intake and intestinal dysfunction [1][2] . The presence of malnutrition in individuals admitted to ICUs has been related to unfavorable outcomes, including higher rates of illness, death, and longer hospital stays.…”

Will ultrasound be able to bring back the lost glory of gastric residual volume?

“…A few years ago, a Journal of the American Medical Association (JAMA) editorial described the “end of an era” for GRV; however, it seems premature to generalize this to all ICU patients [ 9 ]. GRV measurement by ultrasound is non-invasive, can be easily performed bedside, and has the advantage of not being affected by the size or type of tube, and has low EN interference [ 10 ]. While studies to date suggest that ultrasound can be an important tool for GRV measurement, further large-scale studies are needed to restore the lost glory of GRV, showing that it has a positive impact on clinical outcomes in critically ill patients.…”