Adelaide Medicine School, University of Adelaide, Adelaide, Australia.
Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.
Am J Clin Nutr. 2022 Aug 4;116(2):589-598. doi: 10.1093/ajcn/nqac113.
Slow gastric emptying occurs frequently during critical illness and is roughly quantified at bedside by large gastric residual volumes (GRVs). A previously published trial (The Augmented versus Routine approach to Giving Energy Trial; TARGET) reported larger GRVs with energy-dense (1.5 kcal/mL) compared with standard (1.0 kcal/mL) enteral nutrition (EN), warranting further exploration.
To assess the incidence, risk factors, duration, and timing of large GRVs (≥250 mL) and its relation to clinical outcomes in mechanically ventilated adults.
A post-hoc analysis of TARGET data in patients with ≥1 GRV recorded. Data are n (%) or median [IQR].
Of 3876 included patients, 1777 (46%) had ≥1 GRV ≥250 mL, which was more common in males (50 compared with 39%; P < 0.001) and in patients receiving energy-dense compared with standard EN (52 compared with 40%; RR = 1.27 (95% CI: 1.19, 1.36); P < 0.001) in whom it also lasted longer (1 [0-2] compared with 0 [0-1] d; P < 0.001), with no difference in time of onset after EN initiation (day 1 [0-2] compared with 1 [0-2]; P = 0.970). Patients with GRV ≥250 mL were more likely to have the following: vasopressor administration (88 compared with 76%; RR = 1.15 [1.12, 1.19]; P < 0.001), positive blood cultures (16 compared with 8%; RR = 1.92 [1.60, 2.31]; P < 0.001), intravenous antimicrobials (88 compared with 81%; RR = 1.09 [1.06, 1.12]; P < 0.001), and prolonged intensive care unit (ICU) stay (ICU-free days to day 28; 12.9 [0.0-21.0] compared with 20.0 [3.9-24.0]; P < 0.001), hospital stay (hospital-free days to day 28: 0.0 [0.0-12.0] compared with 7.0 [0.0-17.6] d; P < 0.001), ventilatory support (ventilator-free days to day 28: 16.0 [0.0-23.0] compared with 22.0 [8.0-25.0]; P < 0.001), and a higher 90-d mortality (29 compared with 23%; adjusted: RR = 1.17 [1.05, 1.30]; P = 0.003).
Large GRVs were more common in males and those receiving energy-dense formulae, occurred early and were short-lived, and were associated with a number of negative clinical sequelae, including increased mortality, even when adjusted for illness severity. This trial was registered at clinicaltrials.gov as NCT02306746.
危重病患者常出现胃排空缓慢，通过大量胃残留量（GRV）在床边粗略量化。先前发表的一项试验（能量增强与常规方法给予能量试验；TARGET）报告了与标准（1.0 kcal/mL）肠内营养（EN）相比，能量密集型（1.5 kcal/mL）的 GRV 更大，这需要进一步探索。
评估机械通气成人中大量 GRV（≥250 mL）的发生率、危险因素、持续时间和时间，并评估其与临床结局的关系。
对 TARGET 数据进行了一项基于患者的事后分析，记录了≥1 次 GRV≥250 mL 的患者。数据为 n（%）或中位数[IQR]。
在纳入的 3876 例患者中，有 1777 例（46%）有≥1 次 GRV≥250 mL，男性（50%比 39%；P < 0.001）和接受能量密集型配方的患者更常见，与接受标准 EN 的患者相比，GRV≥250 mL 的患者也更常见（52%比 40%；RR=1.27（95%CI：1.19，1.36）；P < 0.001），且持续时间更长（1[0-2]比 0[0-1] d；P < 0.001），在开始 EN 后，GRV 的发病时间无差异（第 1[0-2]天比第 1[0-2]天；P=0.970）。GRV≥250 mL 的患者更有可能出现以下情况：血管加压药的使用（88%比 76%；RR=1.15（1.12，1.19）；P < 0.001），阳性血培养（16%比 8%；RR=1.92（1.60，2.31）；P < 0.001），静脉用抗生素（88%比 81%；RR=1.09（1.06，1.12）；P < 0.001），以及 ICU 住院时间延长（无 ICU 天数至第 28 天；12.9[0.0-21.0]比 20.0[3.9-24.0]；P < 0.001），住院时间延长（无住院天数至第 28 天：0.0[0.0-12.0]比 7.0[0.0-17.6] d；P < 0.001），通气支持时间延长（无通气天数至第 28 天：16.0[0.0-23.0]比 22.0[8.0-25.0]；P < 0.001），以及 90 天死亡率更高（29%比 23%；调整后：RR=1.17（1.05，1.30）；P=0.003）。
男性和接受能量密集型配方的患者更常见大量 GRV，GRV 发生早且持续时间短，与许多不良临床后果相关，包括死亡率增加，即使在调整了疾病严重程度后也是如此。该试验在 clinicaltrials.gov 上注册为 NCT02306746。
