Gastric residual volume during enteral nutrition in ICU patients: the REGANE study

被引:288
作者
Montejo, J. C. [1 ]
Minambres, E. [2 ]
Bordeje, L. [3 ]
Mesejo, A. [4 ]
Acosta, J. [5 ]
Heras, A. [6 ]
Ferre, M. [7 ]
Fernandez-Ortega, F. [8 ]
Vaquerizo, C. I. [9 ]
Manzanedo, R. [10 ]
机构
[1] Hosp Univ 12 Octubre, Unidad Polivalente, ICU, Madrid 28041, Spain
[2] Hosp Univ Marques de Valdecilla, ICU, Santander 39008, Spain
[3] Hosp Badalona Germans Trias & Pujol, ICU, Badalona 08916, Spain
[4] Hosp Clin Univ Valencia, ICU, Valencia 46010, Spain
[5] Hosp Gen Univ Alicante, ICU, Alicante 03010, Spain
[6] Hosp Gen Castello La Plana, ICU, Castellon De La Plana 12004, Spain
[7] Hosp Valle De Hebron, ICU, Barcelona 08035, Spain
[8] Hosp Carlos Haya, ICU, Malaga, Spain
[9] Hosp Univ Fuenlabrada, ICU, Madrid 28942, Spain
[10] Hosp Univ Gran Canaria Dr Negrin, ICU, Las Palmas Gran Canaria 35010, Spain
关键词
Enteral nutrition; Gastric residual volume; Mechanical ventilation; Ventilator-associated pneumonia; Intensive care unit; CRITICALLY-ILL PATIENTS; GASTROINTESTINAL COMPLICATIONS; ENERGY-BALANCE; ASPIRATION; RISK; INTOLERANCE; MOTILITY; FREQUENCY; EFFICACY; MARKER;
D O I
10.1007/s00134-010-1856-y
中图分类号
R4 [临床医学];
学科分类号
100218 [急诊医学];
摘要
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. An open, prospective, randomized study. Twenty-eight intensive care units in Spain. Three hundred twenty-nine intubated and mechanically ventilated adult patients with enteral nutrition (EN). 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). 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. 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.
引用
收藏
页码:1386 / 1393
页数:8
相关论文
共 34 条
[1]
A study of problems associated with the delivery of enteral feed in critically ill patients in five ICUs in the UK [J].
Adam, S ;
Batson, S .
INTENSIVE CARE MEDICINE, 1997, 23 (03) :261-266
[2]
ANBAR R, 2009, CLIN NUTR S, V4, P7
[4]
Gastrointestinal promotility drugs in the critical care setting: A systematic review of the evidence [J].
Booth, CM ;
Heyland, DK ;
Paterson, WG .
CRITICAL CARE MEDICINE, 2002, 30 (07) :1429-1435
[5]
Mechanisms underlying feed intolerance, in the critically ill: Implications for treatment [J].
Deane, Adam ;
Chapman, Marianne J. ;
Fraser, Robert J. ;
Bryant, Laura K. ;
Burgstad, Carly ;
Nguyen, Nam Q. .
WORLD JOURNAL OF GASTROENTEROLOGY, 2007, 13 (29) :3909-3917
[6]
Initial efficacy and tolerability of early enteral nutrition with immediate or gradual introduction in intubated patients [J].
Desachy, Arnaud ;
Clavel, Marc ;
Vuagnat, Albert ;
Normand, Sandrine ;
Gissot, Valerie ;
Francois, Bruno .
INTENSIVE CARE MEDICINE, 2008, 34 (06) :1054-1059
[7]
GASTRODUODENAL MOTILITY IN MECHANICALLY VENTILATED CRITICALLY ILL PATIENTS - A MANOMETRIC STUDY [J].
DIVE, A ;
MOULART, M ;
JONARD, P ;
JAMART, J ;
MAHIEU, P .
CRITICAL CARE MEDICINE, 1994, 22 (03) :441-447
[8]
Computerized energy balance and complications in critically ill patients: An observational study [J].
Dvir, D ;
Cohen, J ;
Singer, P .
CLINICAL NUTRITION, 2006, 25 (01) :37-44
[9]
Equal aspiration rates in gastrically and transpylorically fed critically ill patients [J].
Esparza, J ;
Boivin, MA ;
Hartshorne, MF ;
Levy, H .
INTENSIVE CARE MEDICINE, 2001, 27 (04) :660-664
[10]
Intestinal motility disturbances in intensive care patients pathogenesis and clinical impact [J].
Fruhwald, Sonja ;
Holzer, Peter ;
Metzler, Helfried .
INTENSIVE CARE MEDICINE, 2007, 33 (01) :36-44