Is monitoring of gastric residual volume for critically ill patients with enteral nutrition necessary? A meta‐analysis and systematic review

Abstract

BackgroundThere are many controversies over the necessity of monitoring gastric residual volume in the nursing care of enteral nutrition. We aimed to conduct an updated meta‐analysis to evaluate the effects of monitoring or not monitoring gastric residual volume on patients' outcomes and complications.MethodsWe searched the Cochrane Library database to 15 April 2021 for randomized controlled trials (RCTs) on the effects of gastric residual volume and no gastric residual volume monitoring. Review Manager software was used for data analysis.ResultsA total of seven RCTs involving 1240 enteral nutrition patients were included. Gastric residual volume monitoring was associated with reduced incidence of vomiting (OR2.33, 95% CI:1.68–3.24), whereas no gastric residual volume monitoring was associated with reduced incidence of unnecessary interruptions of enteral nutrition (OR0.38,95% CI:0.26–0.55). There were no significant differences on the incidence of abdominal distention (OR1.87, 95% CI:0.82–4.28), diarrhoea (OR1.03,95% CI:0.74–1.43), VAP (OR0.83, 95%CI:0.37–1.89), duration of mechanical ventilation (MD −0.06,95% CI:−1.22–1.10), length of ICU stay (MD −1.33, 95% CI:−3.58–0.91) and mortality (OR0.90,95% CI:0.61–1.34).ConclusionsNot monitoring gastric residual volume is associated with reduced unnecessary interruptions of enteral nutrition related to inadequate feeding and increased risk of vomiting.

Implementation on a continuum

“…Given these and a myriad of other considerations, it is a wonder that any implementation is initiated, evaluated or sustained in our practice settings. Despite this, many of the articles in this issue speak to successful implementation of nursing innovations and interventions, ranging from, for example, interventions for pregnancy [Yang et al, 2023] or childhood asthma [Fan et al, 2023] through to chronic obstructive pulmonary disease [Liou et al, 2023], from primary care [Cui et al, 2023] through to critical care [Xu et al, 2022]. Across the wide range of nursing practice settings, this editorial highlights many of the tacit components that must be taken into account to achieve change.…”