Authors
- Emami Zeydi, Amir MSN, CCRN
- Sharafkhani, Mohammad MSN
- Armat, Mohammad Reza MSN
Abstract
There are many challenges related to enteral feedings of the mechanically ventilated patient. Among the most often debated issues is the threshold for gastric residual volume before further feeding. This brief article considers the factors to be considered and reviews current thinking on the topic.
Article Content
NUTRITIONAL STATUS is an important factor in maintaining health and healing process, especially in critically ill patients during mechanical ventilation.1 It is believed that nutritional support is a key intervention in caring of patients in intensive care unit (ICU).2 Accordingly, enteral feeding through a nasogastric tube is crucial in maintaining adequate nutrition in such patients.3,4 However, many cases with deficient caloric intake because of feeding interruptions have been reported in ICUs.5
Inappropriate nutritional disruption in mechanically ventilated critically ill patients is associated with increased risk of serious infections, cardiac dysfunction, impaired respiratory epithelium regeneration, weakening respiratory muscles, and prolonged mechanical ventilation.1,6 It may also increase the ICU and hospital stay up to 30% and 50%, respectively.7 Stopping enteral feeding on the basis of high gastric residual volume (GRV) is among the most common reasons for nutritional interruptions.8
Although some studies indicate that GRV monitoring may cause enteral feeding interruptions, yet, more than 97% of critical care nurses use this method for measuring GRV mainly to critically ill patients against aspiration of gastric content.9-11 It is commonly believed that a large amount of GRV put the patients at risk of aspiration.5,12 However, lack of agreement on appropriate threshold of GRV to stop enteral feeding in mechanically ventilated critically ill patients has raised a question in this regard.13,14
A wide range of GRV threshold has been recommended. The Canadian critical care nutrition guideline has recommended a range of 250 to 500 mL, whereas other studies suggest volumes more than 200 mL, to stop the tube feeding.4,15 Also, a minimum value of 500 mL has been proposed by some studies.12,16 A regional survey revealed that the volume on which the decision to stop enteral feeding varied, and the GRV less than 300 mL was the accepted threshold.5 This inconsistency in threshold GRV, as well as the lack of consensus on standardization for withholding and resuming enteral feeding, has caused critical care nurses to decide stopping enteral feeding at the volumes ranging from 50 to at least 500 mL.8-17 For this, it is suggested that the GRV monitoring could be eliminated from the standards of care for critically ill patients under mechanical ventilation.13
Considering the importance of nutritional status of mechanically ventilated critically ill patients, and using GRV monitoring as a routine practice to stop or resume enteral feeding, and also inconsistency in appropriate GRV threshold, more studies are suggested to establish a narrower and widely accepted standard threshold for GRV to help health care providers in making better and confident decisions in this regard.
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enteral feedings; gastric residual volume; mechanically ventilated patient