Sonographic Evaluation of Gastric Residual Volume during Enteral Nutrition in Critically Ill Patients Using a Miniaturized Ultrasound Device

Background: To assess the risk of aspiration, nutrient tolerance, and gastric emptying of patients in ICUs, gastric ultrasound can provide information about the gastric contents. Using established formulas, the gastric residual volume (GRV) can be calculated in a standardized way by measuring the gastric antrum. The purpose of this study was to determine the GRV in a cohort of enterally fed patients using a miniaturized ultrasound device to achieve knowledge about feasibility and the GRV over time during the ICU stay. The findings could contribute to the optimization of enteral nutrition (EN) therapy. Methods: A total of 217 ultrasound examinations with 3 measurements each (651 measurements in total) were performed twice daily (morning and evening) in a longitudinal observational study on 18 patients with EN in the interdisciplinary surgical ICU of Saarland University Medical Center. The measured values of the GRV were analyzed in relation to the clinical course, the nutrition, and other parameters. Results: Measurements could be performed without interrupting the flow of clinical care and without pausing EN. The GRV was significantly larger with sparsely auscultated bowel sounds than with normal and excited bowel sounds (p < 0.01). Furthermore, a significantly larger GRV was present when using a high-caloric/low-protein nutritional product compared to an isocaloric product (p = 0.02). The GRV at the morning and evening measurements showed no circadian rhythm. When comparing the first and last ultrasound examination of each patient, there was a tendency towards an increased GRV (p = 0.07). Conclusion: The GRV measured by miniaturized ultrasound devices can provide important information about ICU patients without restricting treatment procedures in the ICU. Measurements are possible while EN therapy is ongoing. Further studies are needed to establish gastric ultrasound as a management tool in nutrition therapy.

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Monitoring of gastric residual volume during enteral nutrition

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd013335 ◽

2019 ◽

Author(s):

Hideto Yasuda ◽

Natsuki Kondo ◽

Ryohei Yamamoto ◽

Sadaharu Asami ◽

Takayuki Abe ◽

...

Keyword(s):

Enteral Nutrition ◽

Residual Volume ◽

Gastric Residual Volume

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Monitoring enteral nutrition efficacy in ICU patients: is there a place for the Brix value-derived fraction of enteral formula in gastric residual volume?

Critical Care ◽

10.1186/cc8782 ◽

2010 ◽

Vol 14 (Suppl 1) ◽

pp. P550 ◽

Cited By ~ 1

Author(s):

JS Stuer ◽

M Casaer ◽

D Lerouge ◽

J Helderweirt ◽

N Nijs ◽

...

Keyword(s):

Enteral Nutrition ◽

Residual Volume ◽

Gastric Residual Volume ◽

Icu Patients ◽

Enteral Formula ◽

Brix Value

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Practicalities of nutrition support in the intensive care unit: The usefulness of gastric residual volume and prokinetic agents with enteral nutrition

Nutrition ◽

10.1016/j.nut.2010.10.010 ◽

2011 ◽

Vol 27 (5) ◽

pp. 509-512 ◽

Cited By ~ 24

Author(s):

Emma J. Ridley ◽

Andrew R. Davies

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Enteral Nutrition ◽

Nutrition Support ◽

Residual Volume ◽

Gastric Residual Volume ◽

Prokinetic Agents

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Gastric Residual Volume after Split-Dose Bowel Preparation versus Conventional Single-Dose Regimen before Anesthetic Colonoscopy

BioMed Research International ◽

10.1155/2017/6543014 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Shi-gui Xue ◽

Han-lin Chen ◽

Chun-sheng Cheng ◽

Bao-sheng Huang ◽

Hou-de Zhang

Keyword(s):

Single Dose ◽

Polyethylene Glycol ◽

Bowel Preparation ◽

Dose Group ◽

Prospective Observational Study ◽

Residual Volume ◽

Gastric Residual Volume ◽

Split Dose ◽

Bowel Cleansing ◽

Risk Of Aspiration

The aim of this study was to compare gastric residual volume (GRV) in patients given a split-dose versus a conventional single-dose of polyethylene glycol (PEG) preparation before undergoing anesthetic colonoscopy. Methods. In a prospective observational study, we assessed GRV in outpatients undergoing same-day anesthetic gastroscopy and colonoscopy between October 8 and December 30 of 2016. Outpatients were assigned to the split-dose (1 L PEG in the prior evening and 1 L PEG 2–4 h before endoscopy) or single-dose (ingestion of 2 L PEG ≥ 6 h before endoscopy) regimen randomly. Bowel cleansing quality was assessed with the Boston Bowel Preparation Scale (BBPS). Results. The median GRV in the split-dose group (17 ml, with a range of 0–50 ml; N=65) was significantly lower than that in the single-dose group (22 ml, with a range of 0–62 ml; N=64; p=0.005), with a better bowel cleansing quality (BBPS score 8.05±0.82 versus 7.64±1.21; p=0.028). GRV was not associated with diabetes or the use of medications. Conclusions. GRV after a split-dose preparation and fasting for 2–4 hours is not larger than that after a conventional single-dose preparation and fasting for 6–8 hours. The data indicates that the split-dose bowel preparation might not increase the risk of aspiration.

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Characteristics of ICU Patients on Enteral Nutrition According to the Gastric Residual Volume

Journal of Clinical Nutrition ◽

10.15747/jcn.2010.3.1.50 ◽

2010 ◽

Vol 3 (1) ◽

pp. 50-53

Author(s):

Soyoung Yu ◽

Eun-mee Kim ◽

Young Y Cho ◽

Miyong Rha ◽

Jin-young Kim ◽

...

Keyword(s):

Enteral Nutrition ◽

Residual Volume ◽

Gastric Residual Volume ◽

Icu Patients

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Does enteral nutrition infusion rate impact on the gastric residual volume of critically Ill Patients?

Gastroenterology & Hepatology Open Access ◽

10.15406/ghoa.2020.11.00418 ◽

2020 ◽

Vol 12 (2) ◽

pp. 78-82

Author(s):

Poliana Guiomar de Almeida Brasiel ◽

Adriana Soares Torres Melo ◽

Aline Silva de Aguiar ◽

Sheila Cristina Potente Dutra Luquetti

Keyword(s):

Enteral Nutrition ◽

Critically Ill ◽

Critically Ill Patients ◽

Infusion Rate ◽

Residual Volume ◽

Gastric Residual Volume

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Gastric Residual Volume and Aspiration in Critically Ill Patients Receiving Gastric Feedings

American Journal of Critical Care ◽

10.4037/ajcc2008.17.6.512 ◽

2008 ◽

Vol 17 (6) ◽

pp. 512-519 ◽

Cited By ~ 87

Author(s):

Norma A. Metheny ◽

Lynn Schallom ◽

Dana A. Oliver ◽

Ray E. Clouse

Keyword(s):

Prospective Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Gastric Tube ◽

Residual Volume ◽

Gastric Residual Volume ◽

Increased Risk ◽

Gastric Contents ◽

A Prospective Study ◽

Risk Of Aspiration

Background The helpfulness of bedside assessment of gastric residual volume in the prediction of aspiration has been questioned, as has the volume that signals increased risk of aspiration. Objective To describe the association between gastric residual volumes and aspiration of gastric contents. Methods In a prospective study of 206 critically ill patients receiving gastric tube feedings for 3 consecutive days, gastric residual volumes were measured with 60-mL syringes every 4 hours. Measured volumes were categorized into 3 overlapping groups: at least 150 mL, at least 200 mL, and at least 250 mL. Patients were categorized as frequent aspirators if 40% or more of their tracheal secretions were positive for pepsin and as infrequent aspirators if less than 40% of their secretions were positive for pepsin. Gastric residual volumes were compared between the 2 aspiration groups. Results Approximately 39% of the 206 patients had 1 or more gastric residual volumes of at least 150 mL, 27% had 1 or more volumes of at least 200 mL, and 17% had 1 or more volumes of at least 250 mL. Large-bore tubes identified most of the high volumes. Eighty-nine patients were frequent aspirators. Volumes less than 150 mL were common in both aspiration groups. However, the frequent aspirators had a significantly greater frequency of 2 or more volumes of at least 200 mL and 1 or more volumes of at least 250 mL. Conclusions No consistent relationship was found between aspiration and gastric residual volumes. Although aspiration occurs without high gastric residual volumes, it occurs significantly more often when volumes are high.

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