To return or to discard? Randomised trial on gastric residual volume management.
BACKGROUND
The control of gastric residual volume (GRV) is a common nursing intervention in intensive care; however the literature shows a wide variation in clinical practice regarding the management of GRV, potentially affecting patients' clinical outcomes. The aim of this study is to determine the effect of returning or discarding GRV, on gastric emptying delays and feeding, electrolyte and comfort outcomes in critically ill patients.


METHODS
A randomised, prospective, clinical trial design was used to study 125 critically ill patients, assigned to the return or the discard group. Main outcome measure was delayed gastric emptying. Feeding outcomes were determined measuring intolerance indicators, feeding delays and feeding potential complications. Fluid and electrolyte measures included serum potassium, glycaemia control and fluid balance. Discomfort was identified by significant changes in vital signs.


RESULTS
Patients in both groups presented similar mean GRV with no significant differences found (p=0.111), but participants in the intervention arm showed a lower incidence and severity of delayed gastric emptying episodes (p=0.001). No significant differences were found for the rest of outcome measurements, except for hyperglycaemia.


CONCLUSIONS
The results of this study support the recommendation to reintroduce gastric content aspirated to improve GRV management without increasing the risk for potential complications.
Juvé-Udina
Maria-Eulàlia
ME
IDIBELL, Catalan Institute of Health, Gran Via de les Corts Catalanes, 587, Barcelona 08007, Spain. ejuve@gencat.cat
Valls-Miró
Consol
C
Carreño-Granero
Avelina
A
Martinez-Estalella
Gemma
G
Monterde-Prat
David
D
Domingo-Felici
Carmen-Maria
CM
Llusa-Finestres
Joan
J
Asensio-Malo
Gemma
G
D000465:Algorithms; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D015400:Clinical Nursing Research; D003422:Critical Care / Q000379:methods*; D003663:Decision Trees; D004750:Enteral Nutrition / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000451:nursing*; D004868:Equipment Failure; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology; D006947:Hyperkalemia / Q000209:etiology; D007441:Intubation, Gastrointestinal / Q000451:nursing*; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment / Q000379:methods; D011446:Prospective Studies; D053120:Respiratory Aspiration / Q000209:etiology; D018709:Statistics, Nonparametric; D013396:Suction / Q000379:methods / Q000451:nursing; D016896:Treatment Outcome