No Gastric Volume Monitoring Is Not Inferior Strategy
(HealthDay News) – For adults requiring invasive mechanical ventilation, enteral nutrition management without residual gastric volume monitoring is not inferior to a similar protocol which includes monitoring for protection against ventilator-associated pneumonia (VAP), according to a study published in the Jan. 16 issue of the Journal of the American Medical Association.
Jean Reignier, MD, PhD, from the District Hospital Center in La Roche-sur-Yon, France, and colleagues conducted a randomized non-inferiority study involving 449 adults requiring invasive mechanical ventilation for >2 days who were given enteral nutrition within 36 hours after intubation at nine French intensive care units (ICUs). Participants were randomized to the intervention (absence of residual gastric volume monitoring) or to routine residual gastric volume monitoring.
In the intention-to-treat analysis, the researchers found that VAP occurred in 16.7% of the 227 patients in the intervention group and 15.8% of the 222 patients in the control group. Other ICU-acquired infections, mechanical ventilation duration, ICU stay length, or mortality rates did not vary significantly between the groups. In the intervention group, there was a significantly higher proportion of patients receiving 100% of their calorie goal (odds ratio, 1.77). Results were similar in the per-protocol analysis.
"Residual gastric volume monitoring leads to unnecessary interruptions of enteral nutrition delivery with subsequent inadequate feeding and should be removed from the standard care of critically ill patients receiving invasive mechanical ventilation and early enteral nutrition," the authors write.