Critical Illness

CI: Monitoring Criteria: Gastric Residual Volume (2006)

• Intervention
  What gastric volume level should be reached before stopping/holding enteral nutrition in critically ill patients?

  • Conclusion

    Research supports that accepting an isolated GRV of 250 mL, and evaluating the clinical situation with two or more consecutive volumes of 250 mL before stopping/holding EN in critically ill patients, had benefit in terms of greater formula intake.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In critically ill patients, what is the relationship between gastric residual volume and aspiration pneumonia, and what level should be reached before stopping/holding enteral nutrition?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Davies AR, Froomes PRA, French CJ, et al. Randomized comparison of nasojejunal and nasogastric feeding in critically ill patients. Crit Care Med 2002; 30: 586-590
      • Esparza J, Boivin MA, Hartshorne MF, Levy H. Equal aspiration rates in gastrically and transpylorically fed critically ill patients. Intens Care Med 2001; 27: 660-664.
      • Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN. 2003; 27: 355-373.
      • Kearns PJ, Chin D, Mueller L, Wallace K, Jensen WA, Kirsch CM. The incidence of ventilator-associated pneumonia and success in nutrient delivery with gastric vs. small intestinal feeding: A randomized clinical trial. Crit Med. 2000; 28: 1,742-1,746.
      • Kortbeek JB, Haigh PI, Doig C. Duodenal vs. gastric feeding in ventilated blunt trauma patients: A randomized controlled trial. J Trauma. 1999; 46: 992-998.
      • Montecalvo MA, Steger KA, Farber HW, et al. Nutritional outcome and pneumonia in critical care patients randomized to gastic vs. jejunal tube feedings. Crit Care Med. 1992; 20: 1,377-1,387.
      • Montejo JC, Grau T, Acosta J, et al. Multicenter, prospective, randomized, single-blind study comparing the efficacy and gastrointestinal complications of early jejunal feeding in critically ill patients. Crit Care Med 2002; 30: 796-800.
      • Neumann DA, DeLegge MH. Gastric vs small bowel tube feeding in the intensive care unit: A prospective comparison of efficacy. Crit Med 2002; 30: 1,436-1,438.
      • Pinilla JC, Samphire J, Arnold C, et al. Comparison of gastrointestinal tolerance to two enteral feeding protocols in critically ill patients: A prospective, randomized controlled trial. JPEN 2001; 25:81-86.
      • Taylor SJ, Fettes SB, Jewkes C, Nelson R. Prospective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury. Critical Care Medicine 1999; 27: 2525-2531.
  • Search Plan and Results: CI: Monitoring Criteria in Critical Illness 2003
     
• Monitoring and Evaluation
  What is the relationship between gastric residual volume and aspiration pneumonia in critically ill patients?

  • Conclusion

    Adequately powered trials have not been found to evaluate the relationship between GRV and aspiration pneumonia in critically ill patients.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In critically ill patients, what is the relationship between gastric residual volume and aspiration pneumonia, and what level should be reached before stopping/holding enteral nutrition?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Davies AR, Froomes PRA, French CJ, et al. Randomized comparison of nasojejunal and nasogastric feeding in critically ill patients. Crit Care Med 2002; 30: 586-590
      • Esparza J, Boivin MA, Hartshorne MF, Levy H. Equal aspiration rates in gastrically and transpylorically fed critically ill patients. Intens Care Med 2001; 27: 660-664.
      • Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN. 2003; 27: 355-373.
      • Kearns PJ, Chin D, Mueller L, Wallace K, Jensen WA, Kirsch CM. The incidence of ventilator-associated pneumonia and success in nutrient delivery with gastric vs. small intestinal feeding: A randomized clinical trial. Crit Med. 2000; 28: 1,742-1,746.
      • Kortbeek JB, Haigh PI, Doig C. Duodenal vs. gastric feeding in ventilated blunt trauma patients: A randomized controlled trial. J Trauma. 1999; 46: 992-998.
      • Montecalvo MA, Steger KA, Farber HW, et al. Nutritional outcome and pneumonia in critical care patients randomized to gastic vs. jejunal tube feedings. Crit Care Med. 1992; 20: 1,377-1,387.
      • Montejo JC, Grau T, Acosta J, et al. Multicenter, prospective, randomized, single-blind study comparing the efficacy and gastrointestinal complications of early jejunal feeding in critically ill patients. Crit Care Med 2002; 30: 796-800.
      • Neumann DA, DeLegge MH. Gastric vs small bowel tube feeding in the intensive care unit: A prospective comparison of efficacy. Crit Med 2002; 30: 1,436-1,438.
      • Pinilla JC, Samphire J, Arnold C, et al. Comparison of gastrointestinal tolerance to two enteral feeding protocols in critically ill patients: A prospective, randomized controlled trial. JPEN 2001; 25:81-86.
      • Taylor SJ, Fettes SB, Jewkes C, Nelson R. Prospective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury. Critical Care Medicine 1999; 27: 2525-2531.
  • Search Plan and Results: CI: Monitoring Criteria in Critical Illness 2003