Research Article
BibTex RIS Cite

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

Year 2021, Volume: 5 Issue: 2, 157 - 163, 30.08.2021
https://doi.org/10.30565/medalanya.868948

Abstract

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 <0.05], there was no significant difference between the groups in terms of abdominal distension, vomiting, diarrhea, VAC and IVAC (p> 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.


References

  • 1. Dhaliwal R, Cahill N, Lemieux M, Heyland DK. The Canadian critical care nutrition guidelines in 2013: an update on current recommendations and implementation strategies. Nutr Clin Pract. 2014;29(1):29-43. PMID: 24297678
  • 2. Mallampalli A, Mcclave Sa, Snider Hl. Defining tolerance to enteral feeding in the intensive care unit. Clin Nutr. 2000;19(4):213-5. DOI: 10.1054/clnu.2000.0137
  • 3. Metheny NA, Schallom L, Oliver DA, Clouse RE. Gastric residual volume and aspiration in critically ill patients receiving gastric feedings. Am J Crit Care. 2008;17(6):512-9. PMID: 18978236
  • 4. Metheny NA, Mills AC, Stewart BJ. Monitoring for intolerance to gastric tube feedings: a national survey. Am J Crit Care. 2012;21(2):e33-e40. DOI: 10.4037/ajcc2012647
  • 5. Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 201;38(1):48-79. PMID: 30348463 6. Erbay RH, Yalcin AN, Zencir M, Serin S, Atalay H. Costs and risk factors for ventilator-associated pneumonia in a Turkish university hospital's intensive care unit: a case-control study. BMC Pul Med. 2004;4(1):3. DOI: 10.1186/1471-2466-4-3
  • 7. Parrish CR, McClave SA. Checking gastric residual volumes: a practice in search of science. Practical Gastroenterology. 2008;67:33-47.
  • 8. McClave SA, Lukan JK, Stefater JA, Lowen CC, Looney SW, Matheson PJ, et al. Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Crit Care Med. 2005;33(2):324-30. PMID: 15699835
  • 9. Magill SS, Klompas M, Balk R, Burns SM, Deutschman CS, Diekema D, et al. Developing a new, national approach to surveillance for ventilator-associated events. Am J Crit Care. 2013;22(6):469-73. PMID: 24186816
  • 10. Pinilla JC, Samphire J, Arnold C, Liu L, Thiessen B. Comparison of gastrointestinal tolerance to two enteral feeding protocols in critically III patients: a prospective, randomized controlled trial. JPEN J Parenter Enteral Nutr. 2001;25(2):81-6. DOI: 10.1177/014860710102500281
  • 11. Deane A, Chapman MJ, Fraser RJ, Bryant LK, Burgstad C, Nguyen NQ. Mechanisms underlying feed intolerance in the critically ill: implications for treatment. World J Gastroenterol. 2007;13(29):3909-17 DOI: 10.3748/wjg.v13.i29.3909
  • 12. Wøien H, Bjørk IT. Nutrition of the critically ill patient and effects of implementing a nutritional support algorithm in ICU. J Clin Nurs. 2006;15(2):168-77. DOI: 10.1111/j.1365-2702.2006.01262.x
  • 13. Sanderson IR, Croft NM. The anti-inflammatory effects of enteral nutrition. JPEN J Parenter Enteral Nutr. 2005;29(4_suppl):S134-8. DOI: 10.1177/01486071050290S4S134.
  • 14. Flesher ME, Archer KA, Leslie BD, McCollom RA, Martinka GP. Assessing the metabolic and clinical consequences of early enteral feeding in the malnourished patient. JPEN J Parenter Enteral Nutr. 2005;29(2):108-17. DOI: 10.1177/0148607105029002108
  • 15. Montejo J, Minambres E, Bordeje L, Mesejo A, Acosta J, Heras A, et al. Gastric residual volume during enteral nutrition in ICU patients: the REGANE study. Intensive Care Med. 2010;36(8):1386-93. DOI: 10.1007/s00134-010-1856-y
  • 16. McClave SA, DeMeo MT, DeLegge MH, DiSario JA, Heyland DK, Maloney JP, et al. North American summit on aspiration in the critically ill patient: consensus statement. . JPEN J Parenter Enteral Nutr. 2002;26(6_suppl):S80-5. DOI: 10.1177/014860710202600613
  • 17. Metheny NA, Schallom ME, Edwards SJ. Effect of gastrointestinal motility and feeding tube site on aspiration risk in critically ill patients: a review. Heart Lung. 2004;33(3):131-45. DOI: 10.1016/j.hrtlng.2004.02.001
  • 18. Berger MM, Reintam-Blaser A, Calder PC, Casaer M, Hiesmayr MJ, Mayer K, et al. Monitoring nutrition in the ICU. Clinic Nutr.. 2019;38(2):584-93. PMID: 30077342.
  • 19. Williams TA, Leslie GD. A review of the nursing care of enteral feeding tubes in critically ill adults: part II. Intensive Crit Care Nurs. 2005;21(1):5-15. PMID: 15681212.
  • 20. Büyükçoban S, Akan M, Koca U, Eğlen MY, Çiçeklioğlu M, Mavioğlu Ö. Comparison of two different enteral nutrition protocol in critically ill patients. Turk J Anaesthesiol Reanim. 2016;44(5):265-9. DOI: 10.5152/TJAR.2016.92499
  • 21. Desachy A, Clavel M, Vuagnat A, Normand S, Gissot V, François B. Initial efficacy and tolerability of early enteral nutrition with immediate or gradual introduction in intubated patients. Intensive Care Med. 2008;34(6):1054-9. DOI: 10.1007/s00134-007-0983-6
  • 22. Bankhead R, Boullata J, Brantley S, Corkins M, Guenter P, Krenitsky J, et al. ASPEN enteral nutrition practice recommendations. JPEN J Parenter Enteral Nutr.. 2009;33(2):122-67. DOI: 10.1177/0148607108330314.
  • 23. Reignier J, Lascarrou J-B. Residual gastric volume and risk of ventilator-associated pneumonia—reply. JAMA. 2013;309(20):2090-1. PMID: 23695470
  • 24. Fogg L. Home enteral feeding: part 2 current issues in community practice. Br J Community Nurs. 2007;12(7):296, 8-300. DOI: 10.12968/bjcn.2007.12.7.23820
  • 25. Elke G, Felbinger TW, Heyland DK. Gastric residual volume in critically ill patients: a dead marker or still alive? Nutr Clin Pract. 2015;30(1):59-71. DOI: 10.1177/0884533614562841

Yoğun Bakım Hastalarında İki Farklı Gastrik Rezidüel Volümün Gastrointestinal Komplikasyon ve Ventilatör İlişkili Durum İle İlişkisi

Year 2021, Volume: 5 Issue: 2, 157 - 163, 30.08.2021
https://doi.org/10.30565/medalanya.868948

Abstract

Amaç: Çalışmamızın amacı, yoğun bakım ünitesinde solunumu mekanik ventilasyon ile sağlanan hastalarda, toplam gastrik kalıntı hacim miktarları ve iki farklı gastrik kalıntı hacmi eşiği ile gastrointestinal komplikasyon gelişimi arasında ilişki olup olmadığının tespiti, ikinci hedefimiz ise farklı gastrik kalıntı hacimlerinin, ventilatör ilişkili durumlar üzerindeki etkilerini belirlemektir.

Yöntem: Çalışmaya en az 3 gün enteral beslenme planlanan, 18 yaşın üzerindeki 70 adet yetişkin hasta dahil edildi. Birinci gruptaki 35 hastada gastrik kalıntı hacmi eşiği 250 ml, ikinci grupta ise 500 ml olarak belirlendi. İzlem süresi boyunca, belirlenen her iki gastrik kalıntı hacmi eşiğinden herhangi birini aşmamış olan hastaların, 72 saat boyunca kaydedilen gastrik kalıntı hacimlerinin toplam miktarı hesaplandı. Tüm hastaların yüksek gastrik kalıntı hacim oranları, hedef kaloriye ulaşma süreleri, ortalama mide kalıntı hacim miktarları, abdominal distansiyon, kusma, diyare, ventilatör ilişkili durum ve enfeksiyona bağlı ventilatör ilişkili komplikasyon oranları gözlendi.

Bulgular: Çalışmamızın sonunda, iki grup arasında yüksek gastrik kalıntı hacim oranları, belirlenen eşik değerini aşan yüksek gastrik kalıntı hacim oranları arasına, anlamlı bir fark oluşmasına rağmen (p<0.05), her iki grup arasında abdominal distansiyon, kusma, diyare, ventilatör ilişkili durum ve enfeksiyona bağlı ventilatör ilişkili komplikasyon açısından anlamlı bir fark yoktu (p >0.05).

Sonuç: Bu sonuçlar, enteral yolla beslenen yoğun bakım hastalarında, gastrointestinal motiliteyi ölçmek ve komplikasyon oranını azaltmak için gastrik kalıntı hacim miktarlarının ölçülmesinin gerekli olmadığı düşündürmektedir.


References

  • 1. Dhaliwal R, Cahill N, Lemieux M, Heyland DK. The Canadian critical care nutrition guidelines in 2013: an update on current recommendations and implementation strategies. Nutr Clin Pract. 2014;29(1):29-43. PMID: 24297678
  • 2. Mallampalli A, Mcclave Sa, Snider Hl. Defining tolerance to enteral feeding in the intensive care unit. Clin Nutr. 2000;19(4):213-5. DOI: 10.1054/clnu.2000.0137
  • 3. Metheny NA, Schallom L, Oliver DA, Clouse RE. Gastric residual volume and aspiration in critically ill patients receiving gastric feedings. Am J Crit Care. 2008;17(6):512-9. PMID: 18978236
  • 4. Metheny NA, Mills AC, Stewart BJ. Monitoring for intolerance to gastric tube feedings: a national survey. Am J Crit Care. 2012;21(2):e33-e40. DOI: 10.4037/ajcc2012647
  • 5. Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 201;38(1):48-79. PMID: 30348463 6. Erbay RH, Yalcin AN, Zencir M, Serin S, Atalay H. Costs and risk factors for ventilator-associated pneumonia in a Turkish university hospital's intensive care unit: a case-control study. BMC Pul Med. 2004;4(1):3. DOI: 10.1186/1471-2466-4-3
  • 7. Parrish CR, McClave SA. Checking gastric residual volumes: a practice in search of science. Practical Gastroenterology. 2008;67:33-47.
  • 8. McClave SA, Lukan JK, Stefater JA, Lowen CC, Looney SW, Matheson PJ, et al. Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Crit Care Med. 2005;33(2):324-30. PMID: 15699835
  • 9. Magill SS, Klompas M, Balk R, Burns SM, Deutschman CS, Diekema D, et al. Developing a new, national approach to surveillance for ventilator-associated events. Am J Crit Care. 2013;22(6):469-73. PMID: 24186816
  • 10. Pinilla JC, Samphire J, Arnold C, Liu L, Thiessen B. Comparison of gastrointestinal tolerance to two enteral feeding protocols in critically III patients: a prospective, randomized controlled trial. JPEN J Parenter Enteral Nutr. 2001;25(2):81-6. DOI: 10.1177/014860710102500281
  • 11. Deane A, Chapman MJ, Fraser RJ, Bryant LK, Burgstad C, Nguyen NQ. Mechanisms underlying feed intolerance in the critically ill: implications for treatment. World J Gastroenterol. 2007;13(29):3909-17 DOI: 10.3748/wjg.v13.i29.3909
  • 12. Wøien H, Bjørk IT. Nutrition of the critically ill patient and effects of implementing a nutritional support algorithm in ICU. J Clin Nurs. 2006;15(2):168-77. DOI: 10.1111/j.1365-2702.2006.01262.x
  • 13. Sanderson IR, Croft NM. The anti-inflammatory effects of enteral nutrition. JPEN J Parenter Enteral Nutr. 2005;29(4_suppl):S134-8. DOI: 10.1177/01486071050290S4S134.
  • 14. Flesher ME, Archer KA, Leslie BD, McCollom RA, Martinka GP. Assessing the metabolic and clinical consequences of early enteral feeding in the malnourished patient. JPEN J Parenter Enteral Nutr. 2005;29(2):108-17. DOI: 10.1177/0148607105029002108
  • 15. Montejo J, Minambres E, Bordeje L, Mesejo A, Acosta J, Heras A, et al. Gastric residual volume during enteral nutrition in ICU patients: the REGANE study. Intensive Care Med. 2010;36(8):1386-93. DOI: 10.1007/s00134-010-1856-y
  • 16. McClave SA, DeMeo MT, DeLegge MH, DiSario JA, Heyland DK, Maloney JP, et al. North American summit on aspiration in the critically ill patient: consensus statement. . JPEN J Parenter Enteral Nutr. 2002;26(6_suppl):S80-5. DOI: 10.1177/014860710202600613
  • 17. Metheny NA, Schallom ME, Edwards SJ. Effect of gastrointestinal motility and feeding tube site on aspiration risk in critically ill patients: a review. Heart Lung. 2004;33(3):131-45. DOI: 10.1016/j.hrtlng.2004.02.001
  • 18. Berger MM, Reintam-Blaser A, Calder PC, Casaer M, Hiesmayr MJ, Mayer K, et al. Monitoring nutrition in the ICU. Clinic Nutr.. 2019;38(2):584-93. PMID: 30077342.
  • 19. Williams TA, Leslie GD. A review of the nursing care of enteral feeding tubes in critically ill adults: part II. Intensive Crit Care Nurs. 2005;21(1):5-15. PMID: 15681212.
  • 20. Büyükçoban S, Akan M, Koca U, Eğlen MY, Çiçeklioğlu M, Mavioğlu Ö. Comparison of two different enteral nutrition protocol in critically ill patients. Turk J Anaesthesiol Reanim. 2016;44(5):265-9. DOI: 10.5152/TJAR.2016.92499
  • 21. Desachy A, Clavel M, Vuagnat A, Normand S, Gissot V, François B. Initial efficacy and tolerability of early enteral nutrition with immediate or gradual introduction in intubated patients. Intensive Care Med. 2008;34(6):1054-9. DOI: 10.1007/s00134-007-0983-6
  • 22. Bankhead R, Boullata J, Brantley S, Corkins M, Guenter P, Krenitsky J, et al. ASPEN enteral nutrition practice recommendations. JPEN J Parenter Enteral Nutr.. 2009;33(2):122-67. DOI: 10.1177/0148607108330314.
  • 23. Reignier J, Lascarrou J-B. Residual gastric volume and risk of ventilator-associated pneumonia—reply. JAMA. 2013;309(20):2090-1. PMID: 23695470
  • 24. Fogg L. Home enteral feeding: part 2 current issues in community practice. Br J Community Nurs. 2007;12(7):296, 8-300. DOI: 10.12968/bjcn.2007.12.7.23820
  • 25. Elke G, Felbinger TW, Heyland DK. Gastric residual volume in critically ill patients: a dead marker or still alive? Nutr Clin Pract. 2015;30(1):59-71. DOI: 10.1177/0884533614562841
There are 24 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Article
Authors

Mustafa Kaçmaz 0000-0002-8655-3882

Fazilet Şahin Kocaöz 0000-0002-5418-6707

Dilek Destegül 0000-0003-4363-6239

Zeynep Yüksel Turhan 0000-0002-8906-2149

Muhammet Bayraktar 0000-0002-2242-8046

Publication Date August 30, 2021
Submission Date January 26, 2021
Acceptance Date March 21, 2021
Published in Issue Year 2021 Volume: 5 Issue: 2

Cite

Vancouver Kaçmaz M, Şahin Kocaöz F, Destegül D, Yüksel Turhan Z, Bayraktar M. The relationship of gastrointestinal complications and ventilator related status with gastric residual volume in intensive care patients. Acta Med. Alanya. 2021;5(2):157-63.

9705

This Journal is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.