To return or to discard? Randomised trial on gastric residual volume management

Juvé-Udina, Maria-Eulàlia; Valls-Miró, Consol; Carreño-Granero, Avelina; Martinez-Estalella, Gemma; Monterde-Prat, David; Domingo-Felici, Carmen-Maria; Llusa-Finestres, Joan; Asensio-Malo, Gemma

doi:10.1016/j.iccn.2009.06.004

« Previous Next »Intensive and Critical Care Nursing
Volume 25, Issue 5 , Pages 258-267, October 2009

To return or to discard? Randomised trial on gastric residual volume management

Maria-Eulàlia Juvé-Udina
- IDIBELL, Catalan Institute of Health, Gran Via de les Corts Catalanes, 587, Barcelona 08007, Spain
- Corresponding author. Tel.: +34 675786360; fax: +34 934824205.
Consol Valls-Miró
- IDIBELL, Bellvitge University Hospital, ICU 2-1, Feixa Llarga s/n, 08907 Hospitalet de Llobregat, Spain
Avelina Carreño-Granero
- IDIBELL, Bellvitge University Hospital, ICU 2-1, Feixa Llarga s/n, 08907 Hospitalet de Llobregat, Spain
Gemma Martinez-Estalella
- IDIBELL, Bellvitge University Hospital, ICU 2-1, Feixa Llarga s/n, 08907 Hospitalet de Llobregat, Spain
David Monterde-Prat
- IDIBELL, Catalan Institute of Health, Gran Via de les Corts Catalanes, 587, Barcelona 08007, Spain
Carmen-Maria Domingo-Felici
- IDIBELL, Bellvitge University Hospital, ICU 2-1, Feixa Llarga s/n, 08907 Hospitalet de Llobregat, Spain
Joan Llusa-Finestres
- IDIBELL, Bellvitge University Hospital, ICU 2-1, Feixa Llarga s/n, 08907 Hospitalet de Llobregat, Spain
Gemma Asensio-Malo
- IDIBELL, Bellvitge University Hospital, ICU 2-1, Feixa Llarga s/n, 08907 Hospitalet de Llobregat, Spain

Accepted 15 June 2009.

Summary

Background

The control of gastric residual volume (GRV) is a common nursing intervention in intensive care; however the literature shows a wide variation in clinical practice regarding the management of GRV, potentially affecting patients’ clinical outcomes.

The aim of this study is to determine the effect of returning or discarding GRV, on gastric emptying delays and feeding, electrolyte and comfort outcomes in critically ill patients.

Method

A randomised, prospective, clinical trial design was used to study 125 critically ill patients, assigned to the return or the discard group. Main outcome measure was delayed gastric emptying. Feeding outcomes were determined measuring intolerance indicators, feeding delays and feeding potential complications. Fluid and electrolyte measures included serum potassium, glycaemia control and fluid balance. Discomfort was identified by significant changes in vital signs.

Results

Patients in both groups presented similar mean GRV with no significant differences found (p=0.111), but participants in the intervention arm showed a lower incidence and severity of delayed gastric emptying episodes (p=0.001). No significant differences were found for the rest of outcome measurements, except for hyperglycaemia.

Conclusions

The results of this study support the recommendation to reintroduce gastric content aspirated to improve GRV management without increasing the risk for potential complications.

Keywords: Gastric residual volume, Nasogastric tube, Critical care, Clinical trial, Nursing