Effect of gastric residual volume monitoring on incidence of ventilator-associated pneumonia in mechanically ventilated patients admitted to intensive care unit.

Elnaz Faramarzi,Tara Sabzevari,Afshin Iranpour,Sarvin Sanaie,Kamran Shadvar,Hadi Hamishehkar,Ata Mahmoodpoor

doi:10.12669/pjms.36.2.1321

Abstract

Objectives:The value of gastric residual volume (GRV) monitoring in ventilator-associated pneumonia (VAP) has frequently been questioned in the past years. In this trial, the effect of GRV on the frequency of VAP was evaluated in critically ill patients under mechanical ventilation.Methods:This descriptive study was carried out on 150 adult patients admitted to the intensive care unit over a 14-month period, from October 2015 to January 2017. GRV was measured every three hours, and gastric intolerance was defined as GRV>250 cc. The incidence of vomiting and VAP, GRV, length of mechanical ventilation and ICU stay, APACHE II and SOFA scores, and mortality rate were noted.Results:The mean APACHEII and SOFA scores, ICU length of stay, and duration of mechanical ventilation in the GRV>250ml group were significantly higher than in the GRV≤250 ml group (P<0.05). Also, a significantly higher number of patients in the GRV>250ml group experienced infection (62.3%) and vomiting (71.7%) compared with the GRV≤250 group (P<0.01). The highest OR was observed for SOFA score >15 and APACHE II >30, which increased the risk of GVR>250 ml by 10.09 (1.01-99.97) and 8.78 (1.49-51.58), respectively. Moreover, the increase in GVR was found to be higher in the non-survivor than in the survivor group.Conclusion:Increased GRV did not result in increased rates of VAP, ICU length of stay, and mortality. Therefore, the routine measurement of GRV as an important element of the VAP prevention bundle is not recommended in critically ill patients.

Highlights

Enteral nutrition is the standard metabolic support in critically ill patients under mechanical ventilation
Sample size was estimated based on the study of Tume et al.[10] which was conducted to detect the value of caloric intake and for detection of 10% decrease in the incidence of ventilator-associated pneumonia (VAP) The exclusion criteria were history of esophageal gastrointestinal bleeding and surgery, intestinal obstruction, enteral feeding through a jejunostomy tube, acute pancreatitis, and pregnancy
The present results showed that higher acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores are associated with higher gastric residual volume (GRV), which remained significant after adjustment, especially with APACHE II scores>30 and SOFA scores>15

Summary

Introduction

Enteral nutrition is the standard metabolic support in critically ill patients under mechanical ventilation. Correspondence: July 7, 2019 October 18, 2019 October 28, 2019 requirements cannot be met by oral feeding, enteral feeding (EN) is the preferred route of nutrition support.[1] On the other hand, more than 50% of patients in ICU have gastric dysmotility, which leads to slow gastric emptying.[2] Delayed gastric emptying can induce several problems, which can influence ICU outcomes and lead to inadequate caloric intake or infrequent usage of enteral nutrition. Regurgitation, and aspiration can increase the risk of ventilator-associated pneumonia (VAP).[3,4,5] monitoring of gastric residual volume (GRV) is recommended to decrease the incidence of these complications. In cases of high GRV, decreasing the volume of enteral feeding or the formula osmolality seems to be necessary.

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