Liu Fang, Liu Gang, Sun Rui, Wang Jinli, Li Miao, Gong Lichao, Su Yingying, Zhang Yan, Wang Yuan
Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
China National Brain Injury Evaluation Quality Control Center, Xuanwu Hospital, Capital Medical University, Beijing, China.
Front Nutr. 2022 Jun 21;9:871715. doi: 10.3389/fnut.2022.871715. eCollection 2022.
Although recommendations on gastric residual volume (GRV) have been applied to the clinical practice of patients who are intubated, evidence-based data about the GRV of patients who are neurocritically ill are still lacking. We conducted this study to investigate the safety of increased GRV in patients who are neurocritically ill on enteral nutrition (EN) support.
Patients who are neurocritically ill feeding through intragastric enteral tubes were recruited consecutively between July 2018 and June 2021. Patients were divided into a control group (GRV 100 ml) and a study group (GRV 200 ml). Demographic data, admission diagnosis, and severity scores were collected from the patient medical records. The frequency of diet volume ratio (diet received/diet prescribed), the incidence of gastrointestinal complications, and outcome variables were evaluated.
There were 344 patients enrolled, of whom 197 had mechanical ventilation support. High GRV events in the control group were more frequent than those in the study group (38.1 vs. 22.8%, = 0.002). The total gastrointestinal complication rate did not differ significantly between the two groups (study group: 61.1%, 102/167 vs. control group: 67.9%, 114/168). In the study group, two patients had aspiration (1.2 vs. 0%, = 0.245). The study group showed a superior diet volume ratio, but the difference was not significant. The outcomes of the study group were slightly better than those of the control group; however, no significant differences were observed between the two groups concerning the length of stay in the neurointensive care unit (19.5 days vs. 25.3 days) and mortality (10.8 vs. 14.9%) at discharge.
Our results suggest that 200 ml may be a safe normal limit for GRV in patients who are neurocritically ill.
尽管关于胃残余量（GRV）的建议已应用于插管患者的临床实践，但关于神经重症患者GRV的循证数据仍然缺乏。我们开展这项研究以调查神经重症患者在肠内营养（EN）支持下增加GRV的安全性。
2018年7月至2021年6月连续招募通过胃内肠管喂养的神经重症患者。患者被分为对照组（GRV 100 ml）和研究组（GRV 200 ml）。从患者病历中收集人口统计学数据、入院诊断和严重程度评分。评估饮食量比（摄入饮食/规定饮食）的频率、胃肠道并发症的发生率和结局变量。
共纳入344例患者，其中197例接受机械通气支持。对照组的高GRV事件比研究组更频繁（38.1%对22.8%，P = 0.002）。两组的总胃肠道并发症发生率无显著差异（研究组：61.1%，102/167；对照组：67.9%，114/168）。研究组有2例患者发生误吸（1.2%对0%，P = 0.245）。研究组的饮食量比更高，但差异不显著。研究组的结局略优于对照组；然而，两组在神经重症监护病房的住院时间（19.5天对25.3天）和出院时的死亡率（10.8%对14.9%）方面无显著差异。
我们的结果表明，200 ml可能是神经重症患者GRV的安全正常上限。
