To return or to discard? Randomised trial on gastric residual volume management

Abstract

SUMMARYBackground: The control of gastric residual volume (GRV) is a common nursing intervention in intensive care; however the literature shows a wide variation in clinical practice regarding the management of GRV, potentially affecting patients' clinical outcomes.The aim of this study is to determine the effect of returning or discarding GRV, on gastric emptying delays and feeding, electrolyte, and comfort outcomes in critically ill patients.Method: A randomised, prospective, clinical trial design was used to study 125 critically ill patients, assigned to the return or the discard group. Main outcome measure was delayed gastric emptying. Feeding outcomes were determined measuring intolerance indicators, feeding delays and feeding potential complications. Fluid and electrolyte measures included serum potassium, glycaemia control and fluid balance. Discomfort was identified by significant changes in vital signs.Results: Patients in both groups presented similar mean GRV with no significant differences found (p=0,111), but participants in the intervention arm showed a lower incidence and severity of delayed gastric emptying episodes (p=0,001).No significant differences were found for the rest of outcome measurements, except for hyperglycaemia. Conclusions:The results of this study support the recommendation to reintroduce gastric content aspirated to improve GRV management without increasing the risk for potential complications.

Aspiration and Evaluation of Gastric Residuals in the Neonatal Intensive Care Unit

“…They found no increase in complications and improved gastric emptying in adults who were re-fed GRs. 49 In addition, a very small RCT with 35 adults found no difference in complication rates between re-feeding and discarding GRs. 53 Unfortunately, no studies have been conducted regarding discarding or re-feeding GRs in infants.…”

“…48,49 In a small study of NICU nurses, only 4% consistently re-fed aspirated GRs. 48 If GRs are discarded, important elements including hydrochloric acid and pepsin may also be lost.…”

Jordanian nurses' knowledge and responsibility for enteral nutrition in the critically ill

“…Therefore, precautionary cessation of EN when GRV < 400–500 mL should be eradicated from practice (McClave and Snider, , Woien and Bjork, ). However, in an randomized controlled trial (RCT) by Juvé‐Udina et al (), 125 critically ill patients assigned to examine the effectiveness of ‘reintroducing gastric contents’ when GRV is 250 mL or more. This protocol led to maintaining GRVs closer to the physiological level, and minimizing complications.…”

“…This protocol led to maintaining GRVs closer to the physiological level, and minimizing complications. Although re‐introducing GRV is accepted up to 300 mL, additional amounts may cause electrolyte imbalance (Juvé‐Udina et al , , McClave et al , ).…”

Minimizing tracheobronchial aspiration in patients on tube feedings, part 2

“…3,4 Others advocate the initiation of prokinetic agents or conversion to small bowel feedings. 7 What if a GRV can't be obtained? A randomized, prospective trial of critically ill patients showed those who had GRVs of up to 250 mL reinstilled had no greater incidence of NG-tube obstructions, pulmonary aspiration, gastrointestinal (GI) intolerance episodes, or enteral feeding delays than those whose GRVs were discarded.…”