Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2023; 15(8): 1719-1727
Published online Aug 27, 2023. doi: 10.4240/wjgs.v15.i8.1719
Effects of ultrasound monitoring of gastric residual volume on feeding complications, caloric intake and prognosis of patients with severe mechanical ventilation
Xiao-Yan Xu, Hui-Ping Xue, Ming-Jun Yuan, You-Rong Jin, Chun-Xia Huang
Xiao-Yan Xu, Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
Hui-Ping Xue, Ming-Jun Yuan, You-Rong Jin, Emergency Medical Intensive Care Unit, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
Chun-Xia Huang, Department of Emergency Outpatient, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
Author contributions: Xu XY designed research; Xue HP performed research; Yuan MJ contributed new reagents or analytic tools; Jin YR analyzed data; Huang CX and Xu XY wrote the paper.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the Ethics Committee of Affiliated Hospital of Nantong University (Approval No. 2022015).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at 1289811956@qq.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chun-Xia Huang, RN, Associate Chief Nurse, Department of Emergency Outpatient, Affiliated Hospital of Nantong University, No. 20 Xisi Road, Chongchuan District, Nantong 226001, Jiangsu Province, China. 1289811956@qq.com
Received: May 11, 2023
Peer-review started: May 11, 2023
First decision: May 31, 2023
Revised: June 8, 2023
Accepted: June 19, 2023
Article in press: June 19, 2023
Published online: August 27, 2023
Processing time: 106 Days and 11.1 Hours
Abstract
BACKGROUND

Monitoring of gastric residual is an important approach for assessing gastric emptying in patients with mechanical ventilation. By monitoring gastric contents, the enteral nutrition scheme can be adjusted in time to ensure feeding safety.

AIM

To investigate the effects of ultrasound monitoring on the incidence of feeding complications, daily caloric intake and prognosis of patients with severe mechanical ventilation. To analyze the clinical significance of ultrasound monitoring of gastric residual volume (GRV) up to 250 mL to provide a theoretical basis for clinical practice.

METHODS

Patients admitted to the department of emergency medicine of the Affiliated Hospital of Nantong University from January 2018 to June 2022 who received invasive mechanical ventilation and continuous enteral nutrition support within 24-48 h after admission were enrolled in this study. Medical records for patients within 7 d of hospitalization were retrospectively analyzed to compare the incidence of feeding complications, daily caloric intake and clinical prognosis between patients with gastric residual ≥ 250 mL and < 250 mL, as monitored by ultrasound on the third day.

RESULTS

A total of 513 patients were enrolled in this study. Incidences of abdominal distension, diarrhea, and vomiting in the < 250 mL and ≥ 250 mL groups were: 18.4% vs 21.0%, 23.9% vs 32.3% and 4.0% vs 6.5%, respectively; mortality rates were 20.8% vs 22.65%; mechanical ventilation durations were 18.30 d vs 17.56 d while lengths of stay in the intensive care units (ICU) were 19.87 d vs 19.19 ± 5.19 d. Differences in the above factors between groups were not significant. Gastric residual ≥ 250 mL was not an independent risk factor for death and prolonged ICU stay. However, target feeding time of patients in the ≥ 250 mL group was longer than that of patients in the ≥ 250 mL group, and caloric intake (22.0, 23.6, 24.8, 25.3 kcal/kg/d) for patients in the ≥ 250 mL group from the 4th day to the 7th day of hospitalization was lower than that of patients in the ≥ 250 mL group (23.2, 24.8, 25.7, 25.8 kcal/kg/d). On the 4th day (Z = 4.324, P = 0.013), on the 5th day (Z = 3.376, P = 0.033), while on the 6th day (Z = 3.098, P = 0.04), the differences were statistically significant.

CONCLUSION

The use of ultrasound to monitor GRV and undertaking clinical interventions when the monitoring value is ≥ 250 mL has no significant effects on incidences of feeding complications and clinical prognostic outcomes, however, it significantly prolongs the time to reach target feeding, reduces the daily intake of calories during ICU hospitalization, and increases the risk of insufficient nutrition of patients. The accuracy and necessity of monitoring gastric remnants and monitoring frequencies should be investigated further.

Keywords: Gastric residual monitoring; Mechanical ventilation; Vomit; Caloric intake; Prognosis

Core Tip: Gastric residue is only one of the indicators of feeding intolerance and cannot predict whether a patient will experience feeding intolerance. It is not recommended for evaluating the patient's feeding tolerance or prognosis solely based on gastric residue.