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Gastric volume monitoring did not benefit patients on mechanical ventilation, enteral nutrition
Patients receiving mechanical ventilation and enteral nutrition whose residual gastric volume levels were monitored did not experience better outcomes than unmonitored patients in a recent study.
In a multicenter, open-label noninferiority trial in France, researchers randomly assigned 452 patients who required invasive mechanical ventilation and early enteral nutrition to have their residual gastric volume either monitored (controls, n=222) or not monitored (n=230). Incidence of ventilator-associated pneumonia (VAP) was observed in each group during a 90-day period. Three participants in the unmonitored group withdrew their consent and were excluded from intention-to-treat (ITT) analysis, while per-protocol (PP) analysis included 423 patients.
VAP occurred in 16.7% of unmonitored patients, compared with 15.8% of controls, in ITT analysis, and 17.8% and 16.3%, respectively, in PP analysis. Data for cumulative VAP incidence (HR=1.06; 90% CI, 0.72-1.55 in ITT; HR=1.09; 90% CI, 0.74-1.60 in PP) and total episodes (OR=0.98; 90% CI, 0.66-1.43 in ITT; OR=1.01; 90% CI, 0.68-1.49 in PP) were similar between groups.
Investigators noted that unmonitored patients were more likely to meet their targeted calorie intake than controls (OR=4.13; 90% CI, 2.20-7.69 for ITT and OR=4.95; 90% CI, 2.59-9.12 for PP). Unmonitored patients were significantly more likely to vomit than those who were not monitored (OR=1.86; 90% CI, 1.32-2.61 for ITT; OR=1.93; 90% CI, 1.36-2.75 for PP), but more control participants were considered intolerant of enteral nutrition.
No significant differences were observed between groups in the acquisition of infections, diarrhea symptoms, duration of ventilation, length of ICU stay or mortality rates at 28 or 90 days.
“The current study supports the hypothesis that a protocol of enteral nutrition management without residual gastric volume monitoring is not inferior to a similar protocol including residual gastric volume monitoring in terms of protection against VAP,” the researchers concluded. “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.”