Evaluation of the effect on patient parameters of not monitoring gastric residual volume in intensive care patients on a mechanical ventilator receiving enteral feeding: A randomized clinical trial

Introduction. The gastric residual volume (GRV) monitoring in patients with mechanical ventilation (MV) is a common and important challenge. The purpose of this study was to compare the effect of neostigmine and metoclopramide on GRV among MV patients in the intensive care unit (ICU). Methods. In a double-blind randomized clinical trial, a total of 200 mechanically ventilated ICU patients with GRV > 120 ml (6 hours after the last gavage) were randomly assigned into two groups (A and B) with 100 patients in each group. Patients in groups A and B received intravenous infusion of neostigmine at a dose of 2.5 mg/100 ml normal saline and metoclopramide at a dose of 10 mg/100 ml normal saline, within 30 minutes, respectively. GRV was evaluated 5 times for each patient, once before the intervention and 4 times (at 3, 6, 9, and 12 hours) after the intervention. In addition, demographic characteristics including age and gender, as well as severity illness based on the sequential organ failure assessment score (SOFA), were initially recorded for all patients. Results. After adjusting of demographic and clinical characteristics (age, gender, and SOFA score), the generalized estimating equation (GEE) model revealed that neostigmine treatment increased odds of GRV improvement compared to the metoclopramide group ( OR = 2.45 , 95% CI: 1.60-3.76, P < 0.001 ). However, there is a statistically significant time trend (within-subject differences or time effect) regardless of treatment groups ( P < 0.001 ). Conclusion. According to the results, although neostigmine treatment significantly improved GRV in more patients in less time, within 12 hours of treatment, all patients in both groups had complete recovery. Considering that there was no significant difference between the two groups in terms of side effects, it seems that both drugs are effective in improving the GRV of ICU patients.

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A Double-Blind Randomized Clinical Trial Comparing the Effect of Neostigmine and Metoclopramide on Gastric Residual Volume of Mechanically Ventilated ICU Patients

Acta Informatica Medica ◽

10.5455/aim.2016.24.385-389 ◽

2016 ◽

Vol 24 (6) ◽

pp. 385 ◽

Cited By ~ 6

Author(s):

Afshin Baradari ◽

Abbas Alipour ◽

Abolfazl Firouzian ◽

Laleh Moarab ◽

Amir Zeydi

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Residual Volume ◽

Gastric Residual Volume ◽

Double Blind ◽

Icu Patients ◽

Mechanically Ventilated

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Intermittent feeding in intensive care – the theory and practice

10.33699/pis.2021.100.2.66-73 ◽

2021 ◽

Vol 100 (2) ◽

Keyword(s):

Intensive Care ◽

Critically Ill ◽

Enteral Feeding ◽

Critically Ill Patients ◽

Muscle Protein ◽

Muscle Protein Synthesis ◽

Abdominal Discomfort ◽

Residual Volume ◽

Gastric Residual Volume ◽

Intermittent Feeding

Introduction: Nutrition therapy becomes one of the fundamental conditions of a successful outcome in malnourished patients and in critically ill patients. The administration of enteral feeding in critically ill patients is mostly performed by continuous or cyclic feeding. On the contrary, the potential benefits of intermittent feeding include increased muscle protein synthesis. This review outlines the theory of a possible anabolic effect of intermittent feeding. The authors describe their experience with implementation of this method of administration in the intensive care unit including the follow-up of possible complications and adverse effects. Methods: Six patients with intermittent feeding were followed retrospectively during the study period. In addition to demographic data, potential complications related to intermittent enteral feeding (aspiration pneumonia, increased gastric residual volume, abdominal discomfort, osmotic diarrhoea) were evaluated. Results: The average time of intermittent feeding was 8 days. The sum of intermittent feeding days was 63. No aspiration followed by pneumonia was detected during this period. The gastric residual volume did not increase, either. Abdominal discomfort and osmotic diarrhoea were not observed in any patient. Conclusion: Although continuous and cyclic enteral feeding in critically ill patients remains the standard and the most common practice, it is considered as a non-physiological method with possible negative consequences for the patient. On the other hand, intermittent feeding is theoretically associated with respecting of the circadian rhythm and with activation of autophagy. Intermittent feeding increases muscle protein synthesis and supports the release of fatty acids. As shown by our observational study, intermittent administration of enteral nutrition in intensive care can be implemented without any adverse effects; however, it is more time consuming for the nurses.

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