Comment On: Gastric Residual Volume During Enteral Nutrition in ICU Patients: The REGANE Study Montejo JC, Miñambres E, Bordejé L, et al

Abstract

Objective: To compare the effects of increasing the limit for gastric residual volume (GRV) in the adequacy of enteral nutrition. Frequency of gastrointestinal complications and outcome variables were secondary goals. Design: An open, prospective, randomized study. Setting: Twenty‐eight intensive care units in Spain. Patients: Three hundred twenty‐nine intubated and mechanically ventilated adult patients with enteral nutrition (EN). Interventions: EN was administered by nasogastric tube. A protocol for management of EN‐related gastrointestinal complications was used. Patients were randomized to be included in a control (GRV = 200 mL) or in study group (GRV = 500 mL). Measurements and Results: Diet volume ratio (diet received/diet prescribed), incidence of gastrointestinal complications, ICU acquired pneumonia; days on mechanical ventilation and ICU length of stay were the study variables. Gastrointestinal complications were higher in the control group (63.6 vs. 47.8%, P = 0.004), but the only difference was in the frequency of high GRV (42.4 vs. 26.8%, P = 0.003). The diet volume ratio was higher for the study group only during the 1st week (84.48 vs. 88.20%) (P = 0.0002). Volume ratio was similar for both groups in weeks 3 and 4. Duration of mechanical ventilation, ICU length of stay or frequency of pneumonia were similar. Conclusions: Diet volume ratio of mechanically ventilated patients treated with enteral nutrition is not affected by increasing the limit in GRV. A limit of 500 mL is not associated with adverse effects in gastrointestinal complications or in outcome variables. A value of 500 mL can be equally recommended as a normal limit for GRV. (Intensive Care Med. 2010;36:1386–1393. Published online ahead of print March 16, 2010).