Document Detail


Impact of not measuring residual gastric volume in mechanically ventilated patients receiving early enteral feeding: a prospective before-after study.
MedLine Citation:
PMID:  19861528     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Monitoring of residual gastric volume (RGV) to prevent aspiration is standard practice in mechanically ventilated patients receiving early enteral nutrition (EN). No data are available to support a correlation between RGV and adverse event rates. We evaluated whether not measuring RGV affected EN delivery, vomiting, or risk of nosocomial pneumonia. METHODS: Two hundred and five eligible patients with nasogastric feeding within 48 hours after intubation were included in a 7-day prospective before-after study. Continuous 24-hour nutrition was started at 25 mL/h then increased by 25 mL/h every 6 hours, to 85 mL/h. In both groups, intolerance was treated with erythromycin (250 mg IV/6 h) and a delivery rate decrease to the previously well-tolerated rate. RGV monitoring was used during the first study period (n = 102), but not during the subsequent intervention period (n = 103). Intolerance was defined as RGV >250 mL/6 h or vomiting in the standard-practice group and as vomiting in the intervention group. RESULTS: Groups were similar for baseline characteristics. Median daily volume of enteral feeding was higher in the intervention group (1489; interquartile range [IQR], 1349-1647) than in the controls (1381; IQR, 1151-1591; P = .002). Intolerance occurred in 47 (46.1%) controls and 27 (26.2%) intervention patients (P = .004). The vomiting rate did not differ between controls and intervention group patients (24.5% vs 26.2%, respectively; P = .34), and neither was a difference found for ventilator-associated pneumonia (19.6% vs 18.4%; P = .86). CONCLUSION: Early EN without RGV monitoring in mechanically ventilated patients improves the delivery of enteral feeding and may not increase vomiting or ventilator-associated pneumonia.
Authors:
Fanny Poulard; Jerome Dimet; Laurent Martin-Lefevre; Frederic Bontemps; Maud Fiancette; Eva Clementi; Christine Lebert; Benoit Renard; Jean Reignier
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Publication Detail:
Type:  Journal Article     Date:  2009-10-27
Journal Detail:
Title:  JPEN. Journal of parenteral and enteral nutrition     Volume:  34     ISSN:  0148-6071     ISO Abbreviation:  JPEN J Parenter Enteral Nutr     Publication Date:    2010 Mar-Apr
Date Detail:
Created Date:  2010-04-08     Completed Date:  2010-07-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7804134     Medline TA:  JPEN J Parenter Enteral Nutr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  125-30     Citation Subset:  IM    
Affiliation:
Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anti-Bacterial Agents / administration & dosage
Energy Intake*
Enteral Nutrition / adverse effects*,  methods
Erythromycin / administration & dosage
Female
Gastric Emptying
Gastrointestinal Contents*
Humans
Intubation, Gastrointestinal
Male
Middle Aged
Monitoring, Physiologic / methods
Pneumonia, Aspiration / etiology*
Pneumonia, Ventilator-Associated / etiology*
Prospective Studies
Respiration, Artificial / adverse effects*
Vomiting / etiology*
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 114-07-8/Erythromycin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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