Aferição do volume residual gástrico: retrato da prática clínica de enfermeiros

Poveda, Vanessa de Brito; Castilho, Ana Carolina Breviglieri Alves; Nogueira, Lilia de Souza; Ferretti‐Rebustini, Renata Eloah de Lucena; Silva, Rita de Cassia Gengo e

doi:10.1590/s1980-220x2017038803352

Cited by 6 publications

(8 citation statements)

References 15 publications

(25 reference statements)

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“…In a systematic review of 72 studies, the FI was defined based on a large GRV in most of the studies [5] . Although it is recommended by ASPEN guidelines that EN should not be withheld for a GRV of <500 mL, the median GRV threshold reportedly used in clinical practice was 200 to 250 (range, 75–500) mL, which was considered large [5,8–14] . Monitoring GRV and holding or interrupting EN for a large GRV is one of the most conventional and widely accepted nursing practices in the ICU.…”

Section: Discussionmentioning

confidence: 99%

“…[5] Although it is recommended by ASPEN guidelines that EN should not be withheld for a GRV of <500 mL, the median GRV threshold reportedly used in clinical practice was 200 to 250 (range, 75-500) mL, which was considered large. [5,[8][9][10][11][12][13][14] Monitoring GRV and holding or interrupting EN for a large GRV is one of the most conventional and widely accepted nursing practices in the ICU. However, owing to the lack of a standard monitoring method, it has been reported that GRV assessment does not accurately reflect the total volume of the contents available, and the value of the measured volume could be influenced by many factors, including investigator-related and tube-related factors.…”

Section: Discussionmentioning

confidence: 99%

“…We defined FI as the occurrence of vomiting and/or a GRV exceeding 200 mL, which is mostly reported as a cut-off value in clinical practice. [8][9][10][11][12][13][14] However, when we explored the risk factors for FI, we repeated the analysis using vomiting and/or a GRV exceeding 500 mL to define FI.…”

Section: Definitionsmentioning

confidence: 99%

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Prevalence and risk factors of enteral nutrition intolerance in intensive care unit patients: a retrospective study

Guo

Zhang

et al. 2022

Chinese Medical Journal

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Background:Feeding intolerance (FI) among intensive care unit (ICU) patients undergoing early continuous enteral nutrition (EN) is related to poor outcomes. This study aimed to explore the prevalence and risk factors of FI in ICU patients.Methods:We retrospectively enrolled 1057 patients who received early continuous EN via a nasogastric tube between January 2014 and August 2019. The prevalence of FI during the first 7 days of ICU stay was calculated, and the risk factors were investigated using multivariate logistic regression analysis.Results:The prevalence of FI during the first 7 days of ICU stay was 10.95%. FI occurred in 159 of 1057 (15.04%) patients on ICU day 2, 114 of 977 (11.67%) patients on ICU day 3, and 86 of 715 (12.03%) patients on ICU day 7. Mechanical ventilation (MV) (odds ratio [OR]: 1.928, 95% confidence interval [CI]: 1.064–3.493, P = 0.03) was an independent risk factor for FI defined by a gastric residual volume (GRV) of 200 mL and/or vomiting, and acute renal failure (OR: 3.445, 95% CI: 1.115–10.707, P = 0.032) was an independent risk factor of FI defined by a GRV of 500 mL and/or vomiting. Continuous renal replacement therapy (CRRT) was an independent predictor regardless of the FI defined by a GRV of 200 mL (OR: 2.064, 95% CI: 1.233–3.456, P = 0.006) or 500 mL (OR: 6.199, 95% CI: 2.108–18.228, P = 0.001) in the ICU patients.Conclusions:FI occurs frequently in early ICU days, especially in patients receiving MV and CRRT. However, further investigation of a consensus definition of FI and risk factors is still warranted in future studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prevalence and risk factors of enteral nutrition intolerance in intensive care unit patients: a retrospective study

Guo

Zhang

et al. 2022

Chinese Medical Journal

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“…Meanwhile, returning residual gastric aspirates can improve the management of nutrition delivery and balance of fluid and electrolyte; however, this process is prone to higher risk of tube blockage and contamination [9, 29]. It’s well-known that discarding the residual gastric aspirates can increase the risk of reducing energy intake, however, the very abnornal looking aspirates such as bloody, fecal or very bilious aspirates are virtually always discarded since it’s a sign of gastric bleeding or intolerance [30]. The present study did not found any difference between the return and discard intervention in terms of the average potassium level, the episodes of gastric emptying delay, and related adverse complications.…”

Section: Discussionmentioning

confidence: 99%

Is discard better than return gastric residual aspirates: a systematic review and meta-analysis

et al. 2019

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Background The assessment of residual gastric volume is common practice in critical care units. However, the effects and safety of discarding or returning gastric aspirates remain uncertain. Therefore, we aimed to evaluate the role of discarding or returning gastric aspirates on the gastric residual volumes in critically ill patients. Methods A comprehensive, systematic meta-analysis of randomized controlled trials (RCTs) on the efficacy and safety of discarding or returning gastric aspirates in critical ill patients was performed. Studies were identified by searching Pubmed and other databases (from inception to 31 Sept 2018). Summary odd ratios (ORs) or mean differences (MDs) with 95% confidence intervals were calculated using fixed- or random-effects model for outcome assessment. Results: Four RCTs, with a total number of 314 adult patients, were included in the analysis. No significant differences were found in the 48th hour residual volume (MD = 8.89, 95% CI: 11.97 to 29.74), the average potassium level (MD = 0.00, 95% CI: − 0.16 to 0.16), the episodes of gastric emptying delay (OR = 0.98, 95% CI: 0.35 to 2.80), the incidence of aspiration pneumonia (OR = 0.93, 95% CI: 0.14 to 6.17), the episodes of nausea or vomiting (OR = 0.53, 95% CI: 0.07 to 4.13) and diarrhea (OR = 0.99, 95% CI: 0.58 to 1.70). Conclusions No evidence confirms that returning residual gastric aspirates provides more benefits than discarding them without increasing potential complications. Rigorously designed, multi-center, large-sample randomized controlled trials must be further conducted to validate the role of discarding or returning residual gastric aspirates.

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“…Em pacientes com intolerância gastrointestinal, alto risco de aspiração ou aumento do suporte vasopressor, é aconselhável a NP. Em pacientes com distensão gástrica e gastrite erosiva, devem ser considerados o uso de NP suplementar ou de fórmulas entéricas altamente digeríveis, específicas e hiperproteicas, enriquecidas com ácidos graxos ω-3 e/ou com outros nutrientes anti-inflamatórios e imunomoduladores, a exemplo do Zn e vitamina D (Calder et al, 2010;Poveda et al, 2018). Ressalta-se que na COVID-19, a decisão por instituir a NP deve ser cautelosa, bem como deve ser prioridade oferecer imunonutrientes por esta via, como tentativa de compensar o seu efeito deletério na morfologia e resposta imune (Gutiérrez et al, 2019;Huang et al, 2020).…”

Section: Terapia Nutricional Em Pacientes Com Covid-19unclassified

Terapia nutricional em pacientes com COVID-19: algumas considerações e evidências científicas

Santos

Marreiros

Veloso

et al. 2021

RSD

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O presente estudo objetivou revisar a literatura sobre a terapia nutricional em pacientes com COVID-19, destacando alguns nutrientes com potencial funcional que podem beneficiar os pacientes na resposta à infecção e recuperação da doença. Trata-se de uma revisão narrativa simples, desenvolvida a partir de levantamento bibliográfico, leitura de artigos originais e de outras revisões sobre a temática. Os artigos foram recuperados a partir das bases de dados PubMed, Scielo e Web of Science. Os principais achados mostraram que a desnutrição é característica frequente em pacientes infectados por SARS-CoV-2, estando associada à morbidade e mortalidade aumentadas. As evidências científicas confirmam a terapia nutricional como determinante no prognóstico do paciente com COVID-19, com recomendações para oferta hiperproteica e teor adequado de nutrientes com potencial funcional, como os considerados imunomoduladores e anti-inflamatórios. Conclui-se que a terapia nutricional com oferta aumentada de proteínas e rica em imunonutrientes, pode melhorar o prognóstico clínico de pacientes com COVID-19.

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Aferição do volume residual gástrico: retrato da prática clínica de enfermeiros

Abstract: We can highlight the need for nurses' training and further studies focused on the practice for assessing gastric residual volume.

Cited by 6 publications

References 15 publications

Prevalence and risk factors of enteral nutrition intolerance in intensive care unit patients: a retrospective study

Prevalence and risk factors of enteral nutrition intolerance in intensive care unit patients: a retrospective study

Is discard better than return gastric residual aspirates: a systematic review and meta-analysis

Terapia nutricional em pacientes com COVID-19: algumas considerações e evidências científicas

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