Gastric residual volumes in critical illness: What do they really mean?

Ryan T Hurt, Stephen A. McClave

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

The practice of measuring gastric residual volumes (GRVs) has become a routine part of enteral feeding protocols in the critical care setting. However, little scientific evidence indicates that their use improves patient outcomes. The use of GRVs is more of a tradition, which unfortunately guides the delivery of enteral nutrition (EN). The practice of GRVs is predicated on several flawed assumptions. Using GRVs in hospitalized patients assumes that the practice is well standardized, that GRVs reliably and accurately measure gastric contents, and that they sufficiently distinguish normal from abnormal emptying. The practice also assumes that GRVs are easy to interpret, that a tight correlation exists between GRVs and aspiration, and that continuing EN after a high value for GRV is obtained leads to pneumonia and adverse patient outcomes. And finally, clinicians assume that GRVs are an inexpensive " poor man's test" for determining tolerance of EN. This article reviews studies showing the fallacies of these assumptions. Although clinicians are unlikely to stop using GRVs, interpretation of these must be modified so as not to interrupt the delivery of EN. Using a protocol that directs appropriate responses to elevated GRVs should promote the delivery of EN and improve patient outcome.

Original languageEnglish (US)
Pages (from-to)481-490
Number of pages10
JournalCritical Care Clinics
Volume26
Issue number3
DOIs
StatePublished - Jul 2010

Fingerprint

Residual Volume
Critical Illness
Stomach
Enteral Nutrition
Gastrointestinal Contents
Critical Care
Pneumonia

Keywords

  • Enteral nutrition
  • Gastric residual volumes
  • Intensive care unit
  • Patient outcome

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Gastric residual volumes in critical illness : What do they really mean? / Hurt, Ryan T; McClave, Stephen A.

In: Critical Care Clinics, Vol. 26, No. 3, 07.2010, p. 481-490.

Research output: Contribution to journalArticle

@article{1cb01ade2c044042b7d17aafb1d18aea,
title = "Gastric residual volumes in critical illness: What do they really mean?",
abstract = "The practice of measuring gastric residual volumes (GRVs) has become a routine part of enteral feeding protocols in the critical care setting. However, little scientific evidence indicates that their use improves patient outcomes. The use of GRVs is more of a tradition, which unfortunately guides the delivery of enteral nutrition (EN). The practice of GRVs is predicated on several flawed assumptions. Using GRVs in hospitalized patients assumes that the practice is well standardized, that GRVs reliably and accurately measure gastric contents, and that they sufficiently distinguish normal from abnormal emptying. The practice also assumes that GRVs are easy to interpret, that a tight correlation exists between GRVs and aspiration, and that continuing EN after a high value for GRV is obtained leads to pneumonia and adverse patient outcomes. And finally, clinicians assume that GRVs are an inexpensive {"} poor man's test{"} for determining tolerance of EN. This article reviews studies showing the fallacies of these assumptions. Although clinicians are unlikely to stop using GRVs, interpretation of these must be modified so as not to interrupt the delivery of EN. Using a protocol that directs appropriate responses to elevated GRVs should promote the delivery of EN and improve patient outcome.",
keywords = "Enteral nutrition, Gastric residual volumes, Intensive care unit, Patient outcome",
author = "Hurt, {Ryan T} and McClave, {Stephen A.}",
year = "2010",
month = "7",
doi = "10.1016/j.ccc.2010.04.010",
language = "English (US)",
volume = "26",
pages = "481--490",
journal = "Critical Care Clinics",
issn = "0749-0704",
publisher = "W.B. Saunders Ltd",
number = "3",

}

TY - JOUR

T1 - Gastric residual volumes in critical illness

T2 - What do they really mean?

AU - Hurt, Ryan T

AU - McClave, Stephen A.

PY - 2010/7

Y1 - 2010/7

N2 - The practice of measuring gastric residual volumes (GRVs) has become a routine part of enteral feeding protocols in the critical care setting. However, little scientific evidence indicates that their use improves patient outcomes. The use of GRVs is more of a tradition, which unfortunately guides the delivery of enteral nutrition (EN). The practice of GRVs is predicated on several flawed assumptions. Using GRVs in hospitalized patients assumes that the practice is well standardized, that GRVs reliably and accurately measure gastric contents, and that they sufficiently distinguish normal from abnormal emptying. The practice also assumes that GRVs are easy to interpret, that a tight correlation exists between GRVs and aspiration, and that continuing EN after a high value for GRV is obtained leads to pneumonia and adverse patient outcomes. And finally, clinicians assume that GRVs are an inexpensive " poor man's test" for determining tolerance of EN. This article reviews studies showing the fallacies of these assumptions. Although clinicians are unlikely to stop using GRVs, interpretation of these must be modified so as not to interrupt the delivery of EN. Using a protocol that directs appropriate responses to elevated GRVs should promote the delivery of EN and improve patient outcome.

AB - The practice of measuring gastric residual volumes (GRVs) has become a routine part of enteral feeding protocols in the critical care setting. However, little scientific evidence indicates that their use improves patient outcomes. The use of GRVs is more of a tradition, which unfortunately guides the delivery of enteral nutrition (EN). The practice of GRVs is predicated on several flawed assumptions. Using GRVs in hospitalized patients assumes that the practice is well standardized, that GRVs reliably and accurately measure gastric contents, and that they sufficiently distinguish normal from abnormal emptying. The practice also assumes that GRVs are easy to interpret, that a tight correlation exists between GRVs and aspiration, and that continuing EN after a high value for GRV is obtained leads to pneumonia and adverse patient outcomes. And finally, clinicians assume that GRVs are an inexpensive " poor man's test" for determining tolerance of EN. This article reviews studies showing the fallacies of these assumptions. Although clinicians are unlikely to stop using GRVs, interpretation of these must be modified so as not to interrupt the delivery of EN. Using a protocol that directs appropriate responses to elevated GRVs should promote the delivery of EN and improve patient outcome.

KW - Enteral nutrition

KW - Gastric residual volumes

KW - Intensive care unit

KW - Patient outcome

UR - http://www.scopus.com/inward/record.url?scp=77954948448&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77954948448&partnerID=8YFLogxK

U2 - 10.1016/j.ccc.2010.04.010

DO - 10.1016/j.ccc.2010.04.010

M3 - Article

C2 - 20643301

AN - SCOPUS:77954948448

VL - 26

SP - 481

EP - 490

JO - Critical Care Clinics

JF - Critical Care Clinics

SN - 0749-0704

IS - 3

ER -