Jenkins Bethan, Calder Philip C, Marino Luise V
Department of Dietetics/SLT, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK.
J Intensive Care Soc. 2023 Nov 20;25(2):156-163. doi: 10.1177/17511437231210483. eCollection 2024 May.
Monitoring of gastric residual volume (GRV) to assess for enteral feeding intolerance is common practice in the intensive care unit (ICU) setting; however, evidence to support the practice is lacking. The aim of this study was: (i) to gain a perspective of current practice in adult ICUs in the UK around enteral feeding and monitoring of GRV, (ii) to characterise the threshold value used for a high GRV in clinical practice, (iii) to describe the impact of GRV monitoring on enteral feeding provision and (iv) to inform future research into the clinical value of GRV measurement in the adult ICU population.
A web-based survey was sent to all UK adult ICUs. The survey consisted of questions pertaining to (i) nutritional assessment and enteral feeding practices, (ii) enteral feeding intolerance and GRV monitoring and (iii) management of raised GRV.
Responses were received from 101 units. Ninety-eight percent of units reported routinely measuring GRV, with 86% of ICUs using GRV to define enteral feeding intolerance. Threshold values for a high GRV varied from 200 to 1000 ml with frequency of measurement also differing greatly from 2 to 12 hourly. Initiation of pro-kinetic medication was the most common treatment for a high GRV. Fifty-two percent of respondents stated that volume of GRV would influence their decision to stop enteral feeds a lot or very much. Only 28% of units stated that they had guidelines for the technique for monitoring GRV.
Measurement of GRV is the most common method of determining enteral feeding intolerance in adult ICUs in the UK. The practice continues despite evidence of poor validity and reproducibility of this measurement. Further research should be undertaken into the benefit of ongoing GRV measurements in the adult ICU population and alternative markers of enteral feeding intolerance.
监测胃残余量（GRV）以评估肠内营养不耐受是重症监护病房（ICU）的常见做法；然而，缺乏支持该做法的证据。本研究的目的是：（i）了解英国成人ICU中肠内营养及GRV监测的当前实践情况，（ii）确定临床实践中用于定义高GRV的阈值，（iii）描述GRV监测对肠内营养供应的影响，以及（iv）为未来关于成人ICU人群中GRV测量临床价值的研究提供信息。
向英国所有成人ICU发送了基于网络的调查问卷。该问卷包括与以下方面相关的问题：（i）营养评估和肠内营养实践，（ii）肠内营养不耐受和GRV监测，以及（iii）高GRV的管理。
共收到101个单位的回复。98%的单位报告常规测量GRV，86%的ICU使用GRV来定义肠内营养不耐受。高GRV的阈值从200到1000毫升不等，测量频率也差异很大，从每2小时到每12小时一次。启动促动力药物是高GRV最常见的治疗方法。52%的受访者表示GRV的量会很大程度或非常大程度地影响他们停止肠内营养的决定。只有28%的单位表示他们有GRV监测技术的指南。
在英国成人ICU中，测量GRV是确定肠内营养不耐受最常用的方法。尽管有证据表明该测量的有效性和可重复性较差，但这种做法仍在继续。应进一步研究成人ICU人群持续测量GRV的益处以及肠内营养不耐受的替代标志物。
