Impact of not measuring residual gastric volume in mechanically ventilated patients receiving early enteral feeding: a prospective before-after study

JPEN J Parenter Enteral Nutr. Mar-Apr 2010;34(2):125-30. doi: 10.1177/0148607109344745. Epub 2009 Oct 27.

Abstract

Background: Monitoring of residual gastric volume (RGV) to prevent aspiration is standard practice in mechanically ventilated patients receiving early enteral nutrition (EN). No data are available to support a correlation between RGV and adverse event rates. We evaluated whether not measuring RGV affected EN delivery, vomiting, or risk of nosocomial pneumonia.

Methods: Two hundred and five eligible patients with nasogastric feeding within 48 hours after intubation were included in a 7-day prospective before-after study. Continuous 24-hour nutrition was started at 25 mL/h then increased by 25 mL/h every 6 hours, to 85 mL/h. In both groups, intolerance was treated with erythromycin (250 mg IV/6 h) and a delivery rate decrease to the previously well-tolerated rate. RGV monitoring was used during the first study period (n = 102), but not during the subsequent intervention period (n = 103). Intolerance was defined as RGV >250 mL/6 h or vomiting in the standard-practice group and as vomiting in the intervention group.

Results: Groups were similar for baseline characteristics. Median daily volume of enteral feeding was higher in the intervention group (1489; interquartile range [IQR], 1349-1647) than in the controls (1381; IQR, 1151-1591; P = .002). Intolerance occurred in 47 (46.1%) controls and 27 (26.2%) intervention patients (P = .004). The vomiting rate did not differ between controls and intervention group patients (24.5% vs 26.2%, respectively; P = .34), and neither was a difference found for ventilator-associated pneumonia (19.6% vs 18.4%; P = .86).

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

MeSH terms

  • Aged
  • Anti-Bacterial Agents / administration & dosage
  • Energy Intake*
  • Enteral Nutrition / adverse effects*
  • Enteral Nutrition / methods
  • Erythromycin / administration & dosage
  • Female
  • Gastric Emptying
  • Gastrointestinal Contents*
  • Humans
  • Intubation, Gastrointestinal
  • Male
  • Middle Aged
  • Monitoring, Physiologic / methods
  • Pneumonia, Aspiration / etiology*
  • Pneumonia, Ventilator-Associated / etiology*
  • Prospective Studies
  • Respiration, Artificial / adverse effects*
  • Vomiting / etiology*

Substances

  • Anti-Bacterial Agents
  • Erythromycin