Gastric residual volume during enteral nutrition in ICU patients: the REGANE study

Intensive Care Med. 2010 Aug;36(8):1386-93. doi: 10.1007/s00134-010-1856-y. Epub 2010 Mar 16.

Abstract

Objective: To compare the effects of increasing the limit for gastric residual volume (GRV) in the adequacy of enteral nutrition. Frequency of gastrointestinal complications and outcome variables were secondary goals.

Design: An open, prospective, randomized study.

Setting: Twenty-eight intensive care units in Spain.

Patients: Three hundred twenty-nine intubated and mechanically ventilated adult patients with enteral nutrition (EN).

Interventions: EN was administered by nasogastric tube. A protocol for management of EN-related gastrointestinal complications was used. Patients were randomized to be included in a control (GRV = 200 ml) or in study group (GRV = 500 ml).

Measurements and results: Diet volume ratio (diet received/diet prescribed), incidence of gastrointestinal complications, ICU-acquired pneumonia, days on mechanical ventilation and ICU length of stay were the study variables. Gastrointestinal complications were higher in the control group (63.6 vs. 47.8%, P = 0.004), but the only difference was in the frequency of high GRV (42.4 vs. 26.8%, P = 0.003). The diet volume ratio was higher for the study group only during the 1st week (84.48 vs. 88.20%) (P = 0.0002). Volume ratio was similar for both groups in weeks 3 and 4. Duration of mechanical ventilation, ICU length of stay or frequency of pneumonia were similar.

Conclusions: Diet volume ratio of mechanically ventilated patients treated with enteral nutrition is not affected by increasing the limit in GRV. A limit of 500 ml is not associated with adverse effects in gastrointestinal complications or in outcome variables. A value of 500 ml can be equally recommended as a normal limit for GRV.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Enteral Nutrition / adverse effects*
  • Female
  • Gastrointestinal Contents*
  • Humans
  • Intensive Care Units*
  • Length of Stay
  • Male
  • Pneumonia, Ventilator-Associated
  • Prospective Studies
  • Respiration, Artificial
  • Spain