High Gastric Residual Volume Research Articles

Investigating Inappropriate Discontinuations of Enteral Nutrition Related to Gastric Residual Volume in Critically Ill Patients: A Retrospective Observational Descriptive Study

Background: Gastric residual volume (GRV) is measured by nurses in clinical practice as a simple method to assess gastrointestinal intolerance. Nutrition therapy guidelines recommend avoiding enteral tube feeding (ETF) discontinuation if GRV is < 500 mL. Aim: This study aimed to clarify the status of inappropriate ETF discontinuation related to GRV in critically ill patients. Methods: Patients who were ventilated for more than 48 hours in the intensive care unit of a university hospital in 2021 were retrospectively surveyed, and data were collected up to 2 weeks after admission. ETF discontinuation data were collected and categorized as planned or unplanned. The reasons for unplanned discontinuation were further categorized into high GRV, symptoms, and conditions. The reasons and the amount of GRV were analyzed descriptively. Inappropriate ETF discontinuation related to GRV was defined as ETF discontinuation for a GRV of < 500 mL. Results: ETF was discontinued in 10% (270 events / 2,600 orders) of critically ill patients. Unplanned discontinuations accounted for 37% (99/270) of discontinuations, with GRV being the most common reason (43%), followed by nausea and vomiting (8%), and hemodynamic instability (8%). Conclusions: Thirty-seven percent of ETF discontinuations in critically ill patients were unplanned, and 42% of these were inappropriate ETF discontinuations related to GRV. Research results and guideline recommendations need to be disseminated clearly to make more healthcare providers aware of the GRV criteria for discontinuing ETFs.

The impact of guideline recommended protein intake on mortality and length of intensive care unit and hospital stay in critically ill adults: A systematic review

International guidelines recommend a target protein intake of ≥1.2 g/kg/day to all critically ill patients for optimal outcomes. There are however various conflicting data related to this recommendation. The primary objective of this review was to compare a protein intake group (≥1.2 g/kg/day) with a lower protein intake group (<1.2 g/kg/day) in critically ill adult patients on mortality, length of intensive care unit (ICU) and hospital stay. Secondly, the effect of protein intake on length of mechanical ventilation, adverse nutrition-related events and muscle mass and strength parameters were investigated. Sixteen randomised controlled trials (RCTs) of adult patients admitted to an intensive or high care unit and receiving nutrition support in the form of enteral- and/or parenteral nutrition were selected against prespecified eligibility criteria. Two independent reviewers extracted relevant data and assessed the risk of bias of the included studies. Review Manager 5.4.1 was used to analyse data and GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) was used to evaluate the certainty of the evidence. The higher protein group, when compared to the lower protein group, probably results in little to no difference in mortality (risk ratio [RR] 1.01; 95% confidence interval [CI]: 0.89 to 1.14; moderate-certainty evidence); with a probable slight increase in length of ICU stay (mean difference [MD] 0.33; 95% CI -0.57 to 1.23; moderate-certainty) and length of hospital stay (MD 1.72; 95% CI -0.58 to 4.01; moderate-certainty evidence), on average. For secondary outcomes, it was found that the higher protein group probably does not reduce the length of mechanical ventilation (MD 0.08; 95% CI -0.38 to 0.53; moderate-certainty evidence). Higher protein group probably reduces the occurrence of diarrhoea and high gastric residual volume and may reduce the occurrence of constipation. It may also increase nitrogen balance (MD 3.66; 95% CI 1.81 to 5.51; low-certainty evidence). Importantly, there does not seem to be harm associated with the higher protein group, though it should be mentioned that for many of the adverse events in this study, the certainty of evidence was low or very low.

Asuhan Keperawatan Kritis Pada Pasien Chronic Kidney Disease CKD Dengan Intervensi Inovasi Memberikan Nutrisi Enteral Menggunakan Metode Intermiten Feeding Untuk Mengurangi Produksi Residu Lambung di Ruang ICU RSU Kabupaten Tengerang

Background: Critical care developed starting from a need for patients experiencing life-threatening illnesses that could be better met if the patient was cared for in a different room. Chronic Kidney Disease (CKD) is defined as a decrease in kidney function characterized by a glomerular filtration rate (GFR) &lt; 60 ml/min/1.73 m2 that occurs for more than 3 months (Mahesvara, 2020). Nutrition is an important part of the management of critical patients such as those suffering from advanced Chronic Kidney Disease (CKD). Providing nutrition to critical patients is to encourage the healing process. Inaccuracy in administering enteral nutrition can cause complications such as high gastric residual volume, gastric retention, diarrhea, nausea and vomiting. High gastric residues during enteral nutrition increase the risk of pulmonary aspiration which is the most severe complication of enteral nutrition. Intermittent feeding is one method of providing enteral nutrition to prevent these complications. The aim of this research is to provide comprehensive nursing care for patients with Chronic Kidney Disease (CKD). This writing method uses patient intervention and observation carried out for three days, to determine the patient's condition and provide appropriate nursing care which is then documented. Results: Based on the results of the intervention and monitoring carried out, it can be concluded that there are differences in the conditions of gastric residue production before and after the enteral feeding intervention using the intermittent feeding method. With the result criteria of maintaining nutritious food intake increases. Conclusion: In critical patients there is a slowdown in gastric emptying and intestinal motility so that if enteral nutrition is given quickly into the stomach there will be an increase in gastric residue. Nursing action as an evidence base that can be given is in the form of providing enteral nutrition using the intermittent feeding method so that the stomach can be better prepared to receive nutrition because it is given gradually, a stomach that is not completely filled will be able to digest food better and the stomach will empty more quickly, thereby reducing the risk of aspiration.

Measurements of enteral feeding intolerance in critically ill children: a scoping review.

To examine the measurements on enteral feeding intolerance (EFI) in critically ill children. The Joanna Briggs Institute methods for conducting a scoping review were followed. Articles published since 2004 which assessed EFI in critically ill children were identified. A full search strategy was executed in seven English databases (MEDLINE, EMBASE, PubMed, Web of Science, Cochrane Central Register of Controlled Trials, JBI EBP, CINAHL) and four Chinese databases (CNKI, VIP, Wanfang, Sinomed). Two reviewers screened records according to our inclusion and exclusion criteria, and conducted a full-text review of selected articles. The reference lists of all studied selected were screened for additional sources. Relevant data was extracted using a researcher-developed tool. Of the 627 articles identified, 32 were included in this scoping review. Most articles focused on the measurement of high gastric residual volume (n = 22), followed by diarrhea (n = 20), and vomiting (n = 9). Most of the studies were of observational-analytic design (13/32) and experimental design (8/32). This scoping review addressed the complexity and diversity of EFI measurements. Given the importance of adequacy of enteral nutrient intake, we highlighted the necessary to develop individual measurements of EFI, taking the age of children and disease condition into consideration. Further studies can also investigate accurate and objective physiological measurements of EFI to advance EN and improve outcomes in critically ill children.

Gastric residual volume monitoring practices in UK intensive care units: A web-based survey.

Monitoring of gastric residual volume (GRV) to assess for enteral feeding intolerance is common practice in the intensive care unit (ICU) setting; however, evidence to support the practice is lacking. The aim of this study was: (i) to gain a perspective of current practice in adult ICUs in the UK around enteral feeding and monitoring of GRV, (ii) to characterise the threshold value used for a high GRV in clinical practice, (iii) to describe the impact of GRV monitoring on enteral feeding provision and (iv) to inform future research into the clinical value of GRV measurement in the adult ICU population. A web-based survey was sent to all UK adult ICUs. The survey consisted of questions pertaining to (i) nutritional assessment and enteral feeding practices, (ii) enteral feeding intolerance and GRV monitoring and (iii) management of raised GRV. Responses were received from 101 units. Ninety-eight percent of units reported routinely measuring GRV, with 86% of ICUs using GRV to define enteral feeding intolerance. Threshold values for a high GRV varied from 200 to 1000 ml with frequency of measurement also differing greatly from 2 to 12 hourly. Initiation of pro-kinetic medication was the most common treatment for a high GRV. Fifty-two percent of respondents stated that volume of GRV would influence their decision to stop enteral feeds a lot or very much. Only 28% of units stated that they had guidelines for the technique for monitoring GRV. Measurement of GRV is the most common method of determining enteral feeding intolerance in adult ICUs in the UK. The practice continues despite evidence of poor validity and reproducibility of this measurement. Further research should be undertaken into the benefit of ongoing GRV measurements in the adult ICU population and alternative markers of enteral feeding intolerance.

A single-centre observational study of delayed defaecation in brain-injured patients in an adult intensive care unit

BackgroundThe incidence of delayed defaecation is high in enterally fed ventilated patients in intensive care units (ICUs). Those with brain injury may be harmed by increased intracranial pressure if delayed defaecation leads to abdominal distension. There are no studies evaluating a bowel guideline in the treatment of delayed defaecation in ventilated brain-injured ICU patients. ObjectiveThe objective of this study was to assess the incidence and clinical associations of delayed defaecation and level of compliance to an ICU bowel guideline. MethodsData were collected on ventilated adult patients with brain injury admitted for more than 3 days to one New Zealand ICU over a 2-year period. ResultsData were analysed for 117 patients; 56 (48%) who defaecated within 3 days of ICU admission (Group one) and 61 (52%) with delayed defaecation after 3 days (Group two). Compliance with the bowel guideline was low. Only 1 of 61 patients who should have had a rectal examination did so, and only 7 of 61 patients who should have had an aperient on day 3 did so. All seven received Movicol®, which was not part of the guideline. Use of aperients and enemas was found to be associated with stool passage (odds ratio: 93; 95% confidence interval: 5.2–1668; p = 0.002). Patients with delayed defaecation had longer ICU stays (mean 7.1 ± 4 SD vs 5.9 ± 3 days, p = 0.07) and more often had high gastric residual volumes after day 4 (27/61 vs 14/56; p = 0.003). No differences were seen between the groups in the incidence of ventilator-associated pneumonia, bacterial infections, diarrhoea, vomiting, duration of mechanical ventilation, or mortality. ConclusionDelayed defaecation was common, and compliance with the guideline was low. Movicol® and phosphate enemas were effective in stool production.

Effectiveness Of Abdominal Massage On Gastric Residual Volume, Abdominal Distension, And Gastrointestinal Functioning Among Patients With Nasogastric Tube Feeding Admitted In The ICU’s At Selected Hospital-Pilot Study

Abdominal massage is a prevalent non pharmacological intervention for reliving high gastric residual volume, abdominal distension and other some gastro intestinal functioning. It helps to boost the nutritional transition through the gastro intestinal tract, induces peristaltic movement, and consequently lowers the intra abdominal pressure. Moreover, it has been shown to be safe, effective, no pharmacological and non-invasive methods with no side effects.&#x0D; The aim of the study was to determine the effectiveness of abdominal massage on gastric residual volume, abdominal distension and gastro intestinal functioning among patients with nasogastric tube feeding admitted in Intensive Care Units.&#x0D; Subjects: patients who are admitted in the ICU and have nasogastric tube for feeding during the period of data collection. They are divided randomly (cover slip method) in to two groups of 15 in each group (one experimental group and one control group).&#x0D; Setting: The study was conducted in the ICU’s of selected hospital.&#x0D; Results: gastric residual volume, abdominal distension and gastro intestinal functioning were analysed for 2 groups and statistical significant improvement were found among the study group than their control group. The frequency of vomiting episode was significantly reduced among study groups than the control group.&#x0D; Conclusion: Abdominal massage should be considered as part of routine nursing care performed for all patients with nasogastric tube feeding for decreasing the gastric residual volume, abdominal distension and alleviating vomiting.

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Effectiveness of multi interventional components on gastric residual volume, abdominal distension, and gastrointestinal functioning among patients with nasogastric tube feeding admitted in the ICU’s at selected hospital

Abdominal massage and heat application are prevalent non pharmacological interventions for reliving high gastric residual volume, abdominal distension and other some gastro intestinal functioning. It helps to boost the nutritional transition through the gastro intestinal tract, induces peristaltic movement, and consequently lowers the intra abdominal pressure. Moreover, it has been shown to be safe, effective, no pharmacological and non-invasive methods with no side effects. The aim of the study was to determine the effectiveness of multi interventional components on gastric residual volume, abdominal distension and gastro intestinal functioning among patients with nasogastric tube feeding admitted in Intensive Care Units. Subjects: patients who are admitted in the ICU and have nasogastric tube for feeding during the period of data collection. They are divided randomly (cover slip method) in to four groups of 15 in each group (three experimental groups and one control group).Setting: The study was conducted in the ICU’s of selected hospital .Results: gastric residual volume, abdominal distension and gastro intestinal functioning were analysed for 4 groups and statistical significant improvement were found among the study groups than their control group. The frequency of vomiting episode was significantly reduced among study groups than the control group.

Nutrition support practices for critically ill patients with severe acute respiratory syndrome coronavirus-2: A multicentre observational study in Singapore

To improve the nutritional care and resource allocation of critically ill patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), we described their characteristics, treatment modalities and clinical outcomes, and compared their nutrition interventions against the American Society for Parenteral and Enteral Nutrition (ASPEN) recommendations. This was a retrospective observational study conducted in 5 tertiary hospitals in Singapore. Characteristics, treatment modalities, clinical outcomes and nutrition interventions of critically ill patients with SARS-CoV-2 who received enteral and parenteral nutrition were collected between January and May 2020. Among the 83 critically ill patients with SARS-CoV-2, 22 (28%) were obese, 45 (54%) had hypertension, and 21 (25%) had diabetes. Neuromuscular blockade, prone therapy and dialysis were applied in 70% (58), 47% (39) and 35% (29) of the patients, respectively. Refeeding hypophosphataemia and hospital mortality occurred respectively in 6% (5) and 18% (15) of the critically ill patients with SARS-CoV-2. Late enteral nutrition and cardiovascular comorbidities were associated with higher hospital mortality (adjusted relative risk 9.00, 95% confidence interval [CI] 2.25-35.99; 6.30, 95% CI 1.15-34.40, respectively). Prone therapy was not associated with a higher incidence of high gastric residual volume (≥250mL). The minimum caloric (15kcal/kg) and protein (1.2g/kg) recommendations of ASPEN were achieved in 54% (39) and 0% of the patients, respectively. The high obesity prevalence and frequent usage of neuromuscular blockade, prone therapy, and dialysis had considerable implications for the nutritional care of critically ill patients with SARS-CoV-2. They also did not receive adequate calories and protein. More audits should be conducted to refine nutritional interventions and guidelines for this ever-evolving disease.

Comparison of Two Different Threshold Values for the Measurement of Gastric Residual Volume on Enteral Nutrition Support in the Neurocritically Ill Patients.

BackgroundAlthough recommendations on gastric residual volume (GRV) have been applied to the clinical practice of patients who are intubated, evidence-based data about the GRV of patients who are neurocritically ill are still lacking. We conducted this study to investigate the safety of increased GRV in patients who are neurocritically ill on enteral nutrition (EN) support.MethodsPatients who are neurocritically ill feeding through intragastric enteral tubes were recruited consecutively between July 2018 and June 2021. Patients were divided into a control group (GRV 100 ml) and a study group (GRV 200 ml). Demographic data, admission diagnosis, and severity scores were collected from the patient medical records. The frequency of diet volume ratio (diet received/diet prescribed), the incidence of gastrointestinal complications, and outcome variables were evaluated.ResultsThere were 344 patients enrolled, of whom 197 had mechanical ventilation support. High GRV events in the control group were more frequent than those in the study group (38.1 vs. 22.8%, p = 0.002). The total gastrointestinal complication rate did not differ significantly between the two groups (study group: 61.1%, 102/167 vs. control group: 67.9%, 114/168). In the study group, two patients had aspiration (1.2 vs. 0%, p = 0.245). The study group showed a superior diet volume ratio, but the difference was not significant. The outcomes of the study group were slightly better than those of the control group; however, no significant differences were observed between the two groups concerning the length of stay in the neurointensive care unit (19.5 days vs. 25.3 days) and mortality (10.8 vs. 14.9%) at discharge.ConclusionOur results suggest that 200 ml may be a safe normal limit for GRV in patients who are neurocritically ill.

The Nutritional Management of a Post COVID-19 Patient With Recurring High Gastric Residual Volumes: A Case Study

ObjectivesThis case study illustrates the nutritional assessment and management of a post Coronavirus disease-19 (COVID-19) patient with a recurring high gastric residual volume (GRV). Patients with COVID-19 can present with gastrointestinal (GI) symptoms that include a high GRV. The enteral nutrition (EN) guidelines regarding the management of high GRVs vary. The 2016 American Society of Parenteral and Enteral Nutrition (A.S.P.E.N) guidelines were followed. MethodsMr. X, a 67-year-old patient with multiple comorbidities, was admitted to our facility in mid December 2020 and discharged in mid July 2021. Two months after recovering from his COVID-19 infection, Mr. X presented with recurrent high GRVs. EN interventions included reduced feeding rates, use of elemental versus standard formulas, and fiber free versus fiber containing formulas. Other nutritional interventions included the use of parenteral nutrition for supplemental or total nutrition needs. The medical interventions included the management of blood glucose, electrolytes, and medications. The high GRVs continued during his prolonged hospital stay and on discharge despite different nutritional and medical interventions. ResultsDespite following the 2016 A.S.P.E.N guidelines in managing Mr. X’s high GRV there were no clear reductions in the high GRVs. Our observations about GI disturbances in post-COVID-19 patients are supported by other studies. Even after addressing known factors that can contribute to a high GRV such as electrolyte imbalances and the use of hyperosmolar formulas, Mr. X continued to show high GRVs. ConclusionsThe key learning point in this case study is that the patient did not experience the complications that would be anticipated due to GRVs at this magnitude. Neither did he respond as expected to recommended nutritional strategies. It is plausible that a high GRV is associated with post-COVID-19. The observation of an increased number of patients with post-COVID-19 GI complications has nutritional implications for clinical practice. Our study adds to the existing literature about the nutritional management of post-COVID-19 patients. Funding SourcesThere were no funding sources.

Intolerance to Early Nasogastric and Nasojejunal Enteral Nutrition in Patients with Moderately Severe Acute Pancreatitis

RELEVANCE Early enteral nutrition is an essential element of intensive care for acute pancreatitis. Its intolerance is manifested by high gastric residual volumes, pain syndrome, bloating, diarrhea, nausea and vomiting. The relevance of our study is determined by the lack of information on how the routes of nutrient delivery affect its tolerability considering the gradual «as­per­protocol» increase in nutrition volumes for patients with moderately severe acute pancreatitis.THE AIM OF THE STUDY Was to identify the key factors that determine intolerance to early nasogastric and nasojejunal enteral feeding in ICU patients with the early phase of moderately severe acute pancreatitis.MATERIAL AND METHODS We conducted an open randomized controlled trial. Out of 64 patients with predicted severe course of acute pancreatitis, we identified a cohort with moderately severe acute pancreatitis, in which 17 (51.5%) patients received early enteral nutrition through a nasogastric tube, and 16 (48.5%) via an endoscopically placed nasojejunal tube. The criteria for nutrition intolerance were as follows: nasogastric tube discharge of more than 500±100 ml at a time or more than 500 ml/day in comparison with the enterally administered during this period, increased pain, bloating, diarrhea, nausea and vomiting. Using the method of logistic regression, indicators with prognostic significance were determined. The null hypothesis was rejected at p&lt;0.05.RESULTS Regardless of the nutrition route, the progression of multiple organ failure increases the incidence of high gastric residual volumes (SOFA — OR (odds ratio) — 1.337, 95% CI (confidence interval) 1.001–1.787; p = 0.049). Pain syndrome is less common on the day of surgery (OR 0.258, 95% CI 0.110–0.606; p=0.002). Nasojejunal feeding was associated with a lower incidence of nausea and vomiting (OR 0.168, 95% CI 0.06–0.473; p=0.001), but with more diarrhea (OR 6.411, 95% CI 1.274–32.262; p=0.024).CONCLUSION The progression of multiple organ failure increases the incidence of high gastric residual volumes. The pain syndrome is less pronounced on the day of surgery and more intense in case of nasogastric nutrition. Postpyloric nutrition reduces the incidence of nausea and vomiting, but increases diarrhea.

Nutritional intake and gastro-intestinal symptoms in critically ill COVID-19 patients

Background & aimsCritically ill COVID-19 patients seem hypermetabolic and difficult to feed enterally, due to gastro-intestinal (GI) symptoms such as high gastric residual volumes (GRV) and diarrhea. Our aim was to describe the association of nutritional intake and GI symptoms during first 14 days of ICU admission.MethodsObservational study including critically ill adult COVID-19 patients. Data on nutritional intake [enteral nutrition (EN) or parenteral nutrition] and GI symptoms were collected during 14 days after ICU admission. Target energy and protein feeding goals were calculated conform ESPEN guidelines. GI symptoms included GRV (ml/d), vomiting, abdominal distension, and faeces (ml/d). High GRV's were classified as ≥2 times ≥150 ml/d and diarrhea as Bristol stool chart ≥6. GI symptoms were defined as mild if at least one symptom occurred and as moderate when ≥2 symptoms occurred. Acute gastrointestinal injury (AGI) grades of III were classified as GI dysfunction and grades of IV were considered as GI failure with severe impact on distant organs. Linear mixed model analysis was performed to explore the development of nutritional intake and GI symptoms over time at day (D) 0, 4, 10, and 14.ResultsOne hundred and fifty patients were included [75% male; median age 64 years (IQR 54–70)]. BMI upon admission was 28 kg/m2 (IQR 25–33), of which 43% obese (BMI > 30 kg/m2). Most patients received EN during admission (98% D4; 96% D10-14). Mean energy goals increased from 87% at D4 to 93% D10-14 and protein goals (g/kg) were increasingly achieved during admission (84% D4; 93% D10-14). Presence of moderate GI symptoms decreased (10% D0; 6% D4-10; 5% D14), reversely mild GI symptoms increased. Occurrence of GI dysfunction fluctuated (1% D0; 18% D4; 12% D10; 8% D14) and none of patients developed grade IV GI failure. Development of high GRV fluctuated (5% D0; 23% D4; 14% D10; 8% D14) and occurrence of diarrhea slightly increased during admission (5% D0; 22% D4; 25% D10; 27% D14). Linear mixed models showed only an association between AGI grades III and lower protein intake at day 10 (p = 0.020).ConclusionOccurrence of GI symptoms was limited and seems no major barrier for EN in our group of critically COVID-19 patients. Nutritional intake was just below requirements during the first 14 days of ICU admission. The effect on nutritional status remains to be studied.

Effect of pre-operative oral paracetamol on gastric residual volume and pH in young children in the context of a 1-hour clear fluid fast: a randomised controlled trial.

High gastric residual volume and low pH are associated with increased mortality following pulmonary aspiration in animal studies. The use of pre-operative oral paracetamol has not been investigated in younger children and infants in the context of a prescriptive 1-h clear fluid fast aimed at reducing the risk of pulmonary aspiration while improving patient experience. Children aged 1 month up to a weight of 25 kg and scheduled for elective surgery were randomly allocated to receive a prescribed 3.6 ml.kg-1 drink of water alone (water group) or 3 ml.kg-1 water and oral Infant Calpol® syrup (24 mg.ml-1 concentration, equivalent volume 0.6 ml.kg-1 , paracetamol group) 1 h before the induction of anaesthesia. Following induction, a nasogastric tube was used to aspirate gastric contents and the volume and pH were recorded. Ninety-seven children, median (IQR [range]) age 24 (12-45 [1-96]) months and weight 12.4 (9.7-16.0 [2.9-27.0]) kg, were analysed. Median time from drink to induction was 54 (45-60 [21-113]) min. There was no significant difference in gastric residual volume (p = 1) or pH (p = 0.99) between the water and the paracetamol groups. Sub-group analysis revealed no significant difference in gastric residual volume or pH for 29 children who weighed < 10 kg compared with > 10 kg. Using a prescriptive fluid regime of 3 ml.kg-1 of water, the addition of oral paracetamol syrup did not significantly alter gastric residual volume or pH in the context of a 1-h fast in infants and young children.

Applying learning from 1st to the 3rd wave of the covid19 pandemic: nutritional provision in critical care

Rationale: The aim of this analysis was to compare route and adequacy of nutrition support in patients with COVID19 admitted to an intensive care unit (ICU) between March-June 2020 (T1) compared to January-April 2021 (T2). Methods: Parameters related to nutrition support were collected from the records of all patients admitted to ICU with COVID19 with length of stay of ≥7days on mechanical ventilation requiring artificial nutrition support. Data was collected during the late acute phase which was defined as day 4-7 post intubation. Energy and protein intake was compared to calculated estimated nutritional requirements. Results: 35 patients met the inclusion criteria in T1, 94% were on enteral nutrition (EN), 3% parenteral nutrition (PN) and 3% EN+PN. In T2, there were 54 patients (92% EN, 2% PN and 6% EN+PN). Tabled 1March – June 2020 (N=35)January – April 2021 (N=54)P valueEnergy (% requirements met)85 (24)96 (23.0)0.022Protein (% requirements met)68 (28)79 (26.1)0.076 Open table in a new tab Of patients who achieved <70% of energy and protein requirements in T1 (n=17) 35% had constipation or ileus and 47% had GI intolerance (high gastric residual volumes or vomiting). In T2 (n=19), 84% experienced constipation or ileus and 63% had GI intolerance. 35% of patients in T1 had hypernatraemia vs. 47% in T2 and 41% in T1 had hyperglycaemia vs. 100% in T2 despite only 12% and 32% of patients respectively having a history of diabetes. Conclusion: Despite a higher incidence of GI intolerance in T2, a statistically significant improvement in energy targets was noted. There was a clinically significant trend in protein intake which may be attributed to prompt initiation of modular protein supplements or perhaps an earlier transition from fat-based sedation. Meeting protein requirements while preventing overfeeding remains a challenge in the ICU. Disclosure of Interest: None declared.

Nutritional intake and GI symptoms in critically ill covid-19 patients

Rationale: Critically ill COVID-19 patients seem hypermetabolic and difficult to feed enterally, due to high gastric residual volumes (GRV) and diarrhea. Our aim was to describe the association of nutritional intake and gastro-intestinal (GI) symptoms during first 14 days of ICU admission.

Pre-induction Ultrasonographic Evaluation of Gastric Residual Volume in Elective Gastrointestinal Cancer Surgeries.

Pulmonary aspiration of gastric contents during elective surgery remains a major cause of airway-related mortality and morbidity. The preoperative fasting times for solids and liquids have been standardized across various anesthesia society guidelines. Enhanced Recovery After Surgery (ERAS) guidelines now advocate liberal clear fluid intake with carbohydrate loading up to 2h preoperatively. The aim of the study was to assess whether practicing both ASA fasting guidelines and ERAS protocol makes the patients prone to a full stomach. The supine position standard curvilinear ultrasound probe (2-5MHz) with Sonosite M-Turbo ©system was used to obtain the images. Gastric residual volume (GRV) was derived from the cross-sectional area (CSA) using the Perlas and colleagues model. A total of 102 patients were recruited and analyzed. The mean age and BMI were 50.65years ± 13.35years and 22.23kg/m2 ± 3.7kg/m2, respectively. A total of four patients (3.92%) had gastric volume > 1.5ml/kg; out of these four patients, three were female and one was male. We did not observe any case of pulmonary aspiration in any of our patients. In conclusion, even though for elective surgeries, the current fasting guidelines are adequate, these findings cannot be extrapolated to patients with risk factors for high gastric residual volume where further studies need to be performed.

Effect of high gastric residual volume on the critically ill patients' outcomes

Abstract Background: Gastrointestinal (GI) dysfunction is a danger for critically sick patients who receive mechanical breathing. During the course of enteral feeding in the early stages of critical illness, gastric residual volume (GRV) is used as a surrogate metric for GI dysfunction. This study aimed to investigate the effect of high gastric residual volume on critically ill patient outcomes. Design: A prospective, observational research design. Methods: A purposive sample of 60 adult critically ill patients of both sex from the intensive care units (ICUs) at Assiut University Hospital, Egypt were included in the study from August 2020 to April 2021. According to the measurement of gastric residual volume, those patients were not randomly allocated in group 1[the normal limit of gastric residual volume (NGRV) 500]. Five tools were used to collect data included patient's assessment tool, APACHE 11 score, nutritional intervention assessment tool, gastric residual volume assessment tool, and Patient outcomes assessment tools. Results: there was a significant decrease in the Length of ICU stay, duration of mechanical ventilation, and mortality rate in NGRV group than the HGRV group (11.04±4.12 versus 13.91±5.88, 8.43± 4.5 versus 13.02 ±5.04, 30.4% versus 70.3%) respectively. Conclusion: HGRV had an adverse effect on critically ill patients' outcomes such as high ICU mortality, long duration of mechanical ventilation and long ICU stay. Recommendation: Frequent monitoring of gastric residual volume and gastric residual volume protocol and guidelines should be applied in ICU.

The relationship of gastrointestinal complications and ventilator related status with gastric residual volume in intensive care patients

Aim: Our study aimed primarily to determine whether there was a relationship between total gastric residual volume (GRV) amounts and two different GRV thresholds and the development of gastrointestinal intolerance in patients on mechanical ventilation in the intensive care unit (ICU) and secondarily, to determine the effects of different GRV quantities on ventilator-related conditions (VAC).Methods: Seventy patients above the age of 18 who were scheduled to be fed with enteral nutrition (EN) for at least three days, were divided into two groups including 35 patients according to GRV threshold values of 250 ml and 500 ml. The total amounts of GRV of the patients who did not exceed any of the two GRV thresholds during the follow-up period of 72 hours were recorded and calculated. For all patients, necessary data was recorded and high gastric residual volume rates (HGRV), times to reach target calories, mean GRV amounts, abdominal distension, vomiting, diarrhea, VAC and infection-related ventilator-related complications (IVAC) were all observed.Results: Although there were statistically significant differences between the groups in terms of the HGRV rates and the HGRV rates exceeding the determined threshold values [p &amp;lt;0.05], there was no significant difference between the groups in terms of abdominal distension, vomiting, diarrhea, VAC and IVAC (p&amp;gt; 0.05).Conclusion: The results of this study suggest that measuring the amount of GRV in intensive care patients fed by EN via the nasogastric tube in order to decide on gastrointestinal motility function and to reduce the complication rate, is not necessary.