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Impact of Not Measuring Residual Gastric Volume in Mechanically Ventilated Patients Receiving Early Enteral Feeding
Author(s) -
Poulard Fanny,
Dimet Jerome,
MartinLefevre Laurent,
Bontemps Frederic,
Fiancette Maud,
Clementi Eva,
Lebert Christine,
Renard Benoit,
Reignier Jean
Publication year - 2010
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607109344745
Subject(s) - medicine , vomiting , interquartile range , enteral administration , parenteral nutrition , adverse effect , aspiration pneumonia , anesthesia , pneumonia , prospective cohort study , gastroenterology
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.