1. Gastric Residual Volume in the ICU
CAT
Critically Appraised Topic
Gastric Residual Volume in the ICU
PICO QUESTION: Is routine measurement of gastric residual volume (GRV) an effective tool in identifying the risk for aspiration in tube fed patients in the ICU?
Clinical Bottom Line: Measuring the GRV has not been proven to be an effective tool in identifying the risk for aspiration in tube fed patients in the ICU.
Ashley Maas SN, Jamie Siewert SN, Erica Wills SN
Carroll University, Waukesha WI
Collaborating ICU Practice Council Member: Pauline flood, BSN, RN
Waukesha Memorial Hospital, Waukesha, WI
Reference
Level of Evidence
Design
Sample
Findings
Kuppinger, D. D., Rittler, P., Hartl, W. H., & Rüttinger, D. (2013). Use of gastric residual volume to guide enteral nutrition in critically ill patients: A brief systematic review of clinical studies. Nutrition, 29(9),
III
Multi-method approach to identify relevant studies
12 prospective studies (6 were RCA’s) taken from the National Library of Medicine’s MEDLINE database, EMBASE, Cochrane Database of Systematic Reviews of patients in ICUs who received enteral nutrition
For mechanically ventilated patients with a medical diagnosis at admission to the intensive care unit, monitoring of GRV appears unnecessary to guide nutrition. Surgical patients might profit, however, from a low GRV threshold (200 mL).
Metheny, N. A., Schallom, L., Oliver, D. A., Clouse, R. E. (2008). Gastric residual volume and aspiration in critically ill patients receiving gastric feedings.American Journal of Critical Care, 17(6), V
Quasi-experimental design
206 critically ill patients receiving enteral nutrition in the ICU
No consistent relationship was found between aspiration and gastric residual volumes.
Reignier, J., Merceier E., Le Gouge, A., Boulain, T., Desachy, A., Bellec, F., Clavel, M., Frat., J.P., Plantefeve, G., Quenot, J.P., Lascarrou, J.B. (2013). Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding. Journal of American Medical Association (JAMA) 309(3):
Randomized, noninferiority,open-label, multi-center trial RCT
449 included in intention-to-treat analysis (3 had withdrawn)
No statistical significance in the difference between not monitoring or measuring and holding GRV when above a certain levels and the incidence of VAP in the ICU patients. *(Althought patient’s GRV not monitored, met 100% of their nutritional goals)*
Comments of the Evidence: Strengths- large sample size was consistent throughout studies. Highly trained personal taking GRV, high generalizability Weaknesses- When GRV monitoring was not implemented there is no possible estimate of how much GRV the patients had. No significant results for or against GRV, further studies are required.
Applicability: GRV monitoring has not been significantly proven to be an effective practice. Continually monitoring GRV in tube fed patients takes focus away from more important aspects of nursing care, increases hospital expenses, and disrupts necessary tube feedings for critically ill patients.
Evidence Search: PubMed, CINAHL, EBSCO
Key words: gastric residual volume, aspiration, tube feeding