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


CONCLUSIONS
Early EN without RGV monitoring in mechanically ventilated patients improves the delivery of enteral feeding and may not increase vomiting or ventilator-associated pneumonia.
Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France.
Fanny
F
Poulard
Jerome
J
Dimet
Laurent
L
Martin-Lefevre
Frederic
F
Bontemps
Maud
M
Fiancette
Eva
E
Clementi
Christine
C
Lebert
Benoit
B
Renard
Jean
J
Reignier
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002149:Energy Intake; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000379:methods; D004917:Erythromycin / Q000008:administration & dosage; D005260:Female; D005746:Gastric Emptying; D005766:Gastrointestinal Contents; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011015:Pneumonia, Aspiration / Q000209:etiology*; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D014839:Vomiting / Q000209:etiology*
D000900:Anti-Bacterial Agents; D004917:Erythromycin