Effect of Reintroduction of Gastric Aspirate on Gastric Residual Volume Among Patients Receiving Nasogastric/Orogastric Feed Admitted in Icus.

Abstract

Enteral feeding (EF) is considered the preferred method of nutritional support for the critically ill and has reduced septic morbidity in high risk surgical patients, decreasing catabolic response to injury, maintaining bowel mucosal integrity, decreasing translocation of gut bacteria, improving wound healing and reducing septic complications. GI dysmotility implies feeding via a NGT is often associated with large gastric residual volumes, which may lead to increase in the potential for regurgitation and vomiting as used as delay in the achievement of nutritional goals and this can be managed by closely observing gastric residual volume (GRV). 5,6,7 GRV is the amount aspirated from stomach; it indicates that the GIT is functioning normally. 7 The practice of measuring GRV has become a routine part of enteral feeding protocols in the critical care setting, to assess the feeding tolerance, prevent gastric emptying delay and intolerance which may lead to increase in the potential for regurgitation, vomiting and a delay in the achievement of nutritional goals; however if the GRV is more than feed is often withheld unnecessarily. US guidelines state that GRVs of less than 500 ml should not result in termination of enteral feeding. 5,7 Disturbed GE occurs commonly in critically ill patients feed intolerance is an indirect marker of disturbed gastric motility and gastric emptying delay (GED). 2 Metheney et al. also conducted a study and concluded that no consistent relationship was found between aspiration and gastric residual volumes. Although aspiration occurs without high gastric residual volumes, it occurs significantly more often when volumes are high. 8 Juvé-Udina ME et al. showed that GED was almost 50% fewer if the aspirated contents are reintroduced than when the contents are discarded. 2 Some author concluded that High gastric residual volumes are not always indicative of gastric stasis, a low GRV does not protect against aspiration pneumonia. 5