Gastric Residual Volume and Aspiration in Critically Ill Patients Receiving Gastric Feedings

Abstract

Background The helpfulness of bedside assessment of gastric residual volume in the prediction of aspiration has been questioned, as has the volume that signals increased risk of aspiration. Objective To describe the association between gastric residual volumes and aspiration of gastric contents. Methods In a prospective study of 206 critically ill patients receiving gastric tube feedings for 3 consecutive days, gastric residual volumes were measured with 60-mL syringes every 4 hours. Measured volumes were categorized into 3 overlapping groups: at least 150 mL, at least 200 mL, and at least 250 mL. Patients were categorized as frequent aspirators if 40% or more of their tracheal secretions were positive for pepsin and as infrequent aspirators if less than 40% of their secretions were positive for pepsin. Gastric residual volumes were compared between the 2 aspiration groups. Results Approximately 39% of the 206 patients had 1 or more gastric residual volumes of at least 150 mL, 27% had 1 or more volumes of at least 200 mL, and 17% had 1 or more volumes of at least 250 mL. Large-bore tubes identified most of the high volumes. Eighty-nine patients were frequent aspirators. Volumes less than 150 mL were common in both aspiration groups. However, the frequent aspirators had a significantly greater frequency of 2 or more volumes of at least 200 mL and 1 or more volumes of at least 250 mL. Conclusions 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.

Improving Enteral Delivery Through the Adoption of the “Feed Early Enteral Diet Adequately for Maximum Effect (FEED ME)” Protocol in a Surgical Trauma ICU

“…14 However, research suggests high GRV does not correlate with aspiration. 14,26 In a recent randomized trial of 449 patients, the authors suggested GRV had no value in predicting risk of ventilator-associated pneumonia. 12 The control group had EN held for a GRV threshold of 250 mL, while GRV was not checked (and therefore EN not held) in the study group.…”

“…13 According to STICU procedures, a GRV >350 mL was considered high; this is below the recommended maximum amount in the literature yet agreed upon by the STICU nursing staff and leadership. 14,15 EN was held for 4 hours in the presence of GRV >350 mL. The nursing staff charted the occurrence of any these complications in the EHR input/output flow sheet.…”

Early initiated feeding versus early reached target enteral nutrition in critically ill children: An observational study in paediatric intensive care units in Turkey

“…In fact, studies suggest that there is no clear correlation between increased GRV, vomiting, aspiration events and ventilatoracquired pneumonia in adults. [32][33][34] Furthermore, clinical studies demonstrate that early feeding before the return of bowel sounds may actually decrease subsequent GI dysfunction in medical or surgical ICU patients. 35 In conclusion, the use of GRV or bowel sounds appears to be an outmoded and inaccurate marker for GI dysmotility and should likely not be used in PICUs as their use could result in an unnecessary delay in the initiation of feeding and delayed achievement of the target enteral caloric goal in critically ill children.…”

“CAN WE FEED?” A Mnemonic to Merge Nutrition and Intensive Care Assessment of the Critically Ill Patient

“…Nasogastric tubes generate higher GRVs than PEG tubes, and aspiration from larger bore tubes results in higher GRVs than that from small-caliber tubes. 103 Although GRVs provide some information on tolerance, they must not be interpreted in a vacuum without consideration of other clinical parameters. A more prudent approach is to avoid automatic cessation of feeds for GRVs <500 mL in the absence of other signs of intolerance.…”