title: Use of residual volume as a marker for enteral feeding intolerance: prospective blinded comparison with physical examination and radiographic findings.
abstract: High gastric residual volumes (RVs) are a frequent cause for cessation of total enteral nutrition (TEN). This study was designed to determine the RV that indicates intolerance or inadequate gastric emptying and to compare the RV findings in a blinded fashion with those findings obtained on physical examination and radiography. Twenty healthy normal volunteers (HNV), 8 stable patients with gastrostomy tubes (GTP), and 10 critically ill patients (CIP) were evaluated prospectively for 8 hours while receiving TEN. No subjects were clearly intolerant (ie, vomiting, aspiration). Of the total RVs recorded, 13.1% were greater than or equal to 150 mL in the CIP group, whereas only 2.4% of the RVs were greater than or equal to 150 mL in the HNV group. None of the RVs in the GTP group were greater than or equal to 150 mL. Objective scores on physical examination failed to correlate with RV (p = .397), as did objective scores on radiography (p = .742). However, objective scores on physical examination were significantly related to scores on radiography (p = .016). Abnormal physical examination findings were found in 4 out of 11 patients (GTP + CIP) with RVs less than 100 mL and in 6 out of 7 with RVs greater than or equal to 100 mL. Abnormal radiographic results were found in 6 out of 11 patients with RVs less than 100 mL, in 7 out of 7 patients with RVs greater than or equal to 100 mL, and in 4 out of 20 HNVs. There was no difference in RVs obtained from the supine or right lateral decubitus positions.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: University of Louisville, School of Medicine, Department of Medicine, Kentucky 40292.
authors.forename: S A
authors.initials: SA
authors.lastname: McClave
authors.forename: H L
authors.initials: HL
authors.lastname: Snider
authors.forename: C C
authors.initials: CC
authors.lastname: Lowen
authors.forename: A J
authors.initials: AJ
authors.lastname: McLaughlin
authors.forename: L M
authors.initials: LM
authors.lastname: Greene
authors.forename: R J
authors.initials: RJ
authors.lastname: McCombs
authors.forename: L
authors.initials: L
authors.lastname: Rodgers
authors.forename: R A
authors.initials: RA
authors.lastname: Wright
authors.forename: T M
authors.initials: TM
authors.lastname: Roy
authors.forename: M P
authors.initials: MP
authors.lastname: Schumer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000628:therapy; D004750:Enteral Nutrition / Q000009:adverse effects*; D005746:Gastric Emptying; D005774:Gastrostomy; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011446:Prospective Studies; D011859:Radiography; D013270:Stomach / Q000000981:diagnostic imaging / Q000473:pathology*