School of Nursing, Medical College of Soochow University, Jiangsu, China; Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Nursing Department, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Int J Nurs Stud. 2019 Mar;91:86-93. doi: 10.1016/j.ijnurstu.2018.11.005. Epub 2019 Jan 3.
Monitoring gastric residual volume has been a common practice in intensive care patients receiving enteral feeding worldwide. Recent studies though, have challenged the reliability and necessity of this routine monitoring process. Several studies even reported improvements in the delivery of enteral feeding without monitoring gastric residual volume, while incurring no additional adverse events. However, the benefit of monitoring gastric residual volume remains controversial in intensive care patients.
The aim of this review is to identify the effects of not monitoring gastric residual volume in intensive care patients through a meta-analysis of the data pooled from published studies that meet our inclusion criteria.
A systematic review DATA SOURCES: An electronic search of Embase, Pubmed, and the Cochrane Library was completed up to April 2018. The data included basic population characteristics, related complications, mortality, duration of mechanical ventilation and intensive care unit length of stay.
Eligibility and methodological quality of the studies were assessed by two researchers independently according to the Joanna Briggs Institute guidelines. The Review Manager Software was used to calculate the pooled risk ratio (RR), weighted mean difference, and the corresponding 95% confidential interval (95% CI). Sensitivity analyses were done by excluding each study. Publication bias analyses were conducted to avoid the exaggerated effect of the overall estimates.
Five studies involving 998 patients were included in this meta-analysis. Compared with monitoring gastric residual volume, not monitoring gastric residual volume decreased the rate of feeding intolerance in critically ill patients (RR = 0.61, 95%CI 0.51-0.72), and did not result in an increment in the rate of mortality (RR = 0.97, 95%CI 0.73-1.29, P = 0.84) or the rate of ventilator-associated pneumonia (RR = 1.03, 95%CI 0.74-1.44, P = 0.85). There were also no differences in the duration of mechanical ventilation (MD = 0.09, 95%CI, -0.99 to 1.16, P = 0.88) or intensive care unit length of stay (MD=-0.18, 95%CI, -1.52 to 1.17, P = 0.79).
Except for an increased risk of vomiting, the absence of monitoring gastric residual volume was not inferior to routine gastric residual volume monitoring in terms of feeding intolerance development, mortality, and ventilator-associated pneumonia in intensive care patients. There is encouraging evidence that not measuring gastric residual volume does not induce additional harm to the patients. More multicenter, randomized clinical trials are required to verify these findings.
监测胃残留量已成为全球接受肠内喂养的重症监护患者的常规做法。然而，最近的研究质疑了这一常规监测过程的可靠性和必要性。一些研究甚至报告说，在不监测胃残留量的情况下，肠内喂养的输送得到了改善，而没有发生额外的不良事件。然而，在重症监护患者中，监测胃残留量的益处仍存在争议。
通过对符合纳入标准的已发表研究数据进行荟萃分析，确定不监测重症监护患者胃残留量的效果。
系统综述
对 Embase、Pubmed 和 Cochrane 图书馆进行了电子检索，检索截至 2018 年 4 月。数据包括基本人群特征、相关并发症、死亡率、机械通气时间和重症监护病房住院时间。
两名研究人员根据 Joanna Briggs 研究所的指南独立评估研究的合格性和方法学质量。使用 Review Manager 软件计算汇总风险比（RR）、加权均数差和相应的 95%置信区间（95%CI）。通过排除每项研究进行敏感性分析。进行发表偏倚分析以避免总体估计的夸大效应。
这项荟萃分析纳入了 5 项涉及 998 名患者的研究。与监测胃残留量相比，不监测胃残留量可降低危重症患者喂养不耐受的发生率（RR=0.61，95%CI 0.51-0.72），且不会增加死亡率（RR=0.97，95%CI 0.73-1.29，P=0.84）或呼吸机相关性肺炎的发生率（RR=1.03，95%CI 0.74-1.44，P=0.85）。机械通气时间（MD=0.09，95%CI，-0.99 至 1.16，P=0.88）或重症监护病房住院时间（MD=-0.18，95%CI，-1.52 至 1.17，P=0.79）也无差异。
除了呕吐风险增加外，不监测胃残留量在重症监护患者中与常规监测胃残留量相比，在喂养不耐受发展、死亡率和呼吸机相关性肺炎方面并无劣势。有令人鼓舞的证据表明，不测量胃残留量不会对患者造成额外的伤害。需要更多的多中心、随机临床试验来验证这些发现。
