Gradual sucrose gastric loading test: A method for the prediction of nonsuccess gastric enteral feeding in critically ill surgical patients.
OBJECTIVE
Intolerance of gastric enteral feeding (GEN) commonly occurs in surgical Intensive Care Unit (SICU). A liquid containing sugar could prolong gastric emptying time. This study was to propose a method for prediction of nonsuccess GEN using gastric volume after loading (GVAL) following gradual sucrose gastric loading.


METHODS
Mechanical ventilator supported and hemodynamically stable patients in SICU were enrolled. About 180-240 min before the GEN starting, a sucrose solution (12.5%; 450 mosmole/kg, 800 mL) was administered via gastric feeding tube over 30 min with 45° head upright position. GVAL was measured at 30, 60, 90, and 120 min after loading. GEN success status using clinical criteria was assessed at 72 h after the starting GEN protocol. The receiving operating characteristic (ROC) and c statistic were used for discrimination at each time point of GVAL.


RESULTS
A total of 32 patients were enrolled and completed the protocol. 14 patients (43.7%) were nonsuccessful GEN. The nonsuccess group was found to have significantly more GVAL than the other group at all-time points during the test (P < 0.05). The most discriminating point of GVAL for the prediction of nonsuccess was 150 mL at 120 min after loading with a sensitivity of 92.3%, specificity of 88.9%, positive predictive value of 85.7%, negative predictive value of 94.1%, and ROC area 0.97 (95% confidence interval 0.91-1.00).


CONCLUSIONS
A high GVAL following sucrose gastric loading test might be a method to predict nonsuccess GEN in critically ill surgical patients.
Department of Surgery, Division of Surgical Critical Care and Trauma, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Kaweesak
K
Chittawatanarat
Department of Surgery, Division of Surgical Critical Care and Trauma, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Suun
S
Sathornviriyapong
Department of Hospital Services, Dietary Unit, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand.
Yaowalak
Y
Polbhakdee
Critical illness; enteral nutrition; predictions; stomach contents; sucrose