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Gastric volume monitoring in ventilated patients receiving enteral feeding

A study in this week's issue of the Journal of the American Medical Association examines the effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding.

News image

Monitoring of residual gastric volume is recommended to prevent ventilator-associated pneumonia (VAP) in patients receiving early enteral nutrition.

However, studies have challenged the reliability and effectiveness of this measure.

Dr Jean Reignier and colleagues examined wether the risk of VAP is increased when residual gastric volume is not monitored compared with routine residual gastric volume monitoring in patients receiving invasive mechanical ventilation and early enteral nutrition.

The team performed a randomized, noninferiority, open-label, multicenter trial conducted from 2010 through 2011 in adults requiring invasive mechanical ventilation for more than 2 days and given enteral nutrition within 36 hours after intubation at 9 French intensive care units (ICUs).

The team randomized 452 patients, and 449 included in the intention-to-treat analysis.

The prestated noninferiority margin was 10%
Journal of the American Medical Association

Intolerance to enteral nutrition was based only on regurgitation and vomiting in the intervention group, and based on residual gastric volume greater than 250 mL at any of the 6 hourly measurements and regurgitation or vomiting in the control group.

The team's main outcome measures included the proportion of patients with at least 1 VAP episode within 90 days after randomization, as assessed by an adjudication committee blinded to patient group.

The team observed that the prestated noninferiority margin was 10%.

The doctors observed that results in the intention-to-treat population, VAP occurred in 38 of 227 patients in the intervention group, and in 35 of 222 patients in the control group.

There were no significant between-group differences in other ICU-acquired infections, mechanical ventilation duration, ICU stay length, or mortality rates.

The team found that the proportion of patients receiving 100% of their calorie goal was higher in the intervention group.

The research team obtained similar results in the per-protocol population.

Dr Reignier's team concluded, "Among adults requiring mechanical ventilation and receiving early enteral nutrition, the absence of gastric volume monitoring was not inferior to routine residual gastric volume monitoring in terms of development of VAP."

JAMA 2013; 309(3): 249-256
17 January 2013

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