Assessment of routinly used enteral nutrition protocols in critically ill patients

Background: Malnutrition is common in critically ill patients and is associated with morbidity and mortality as high as 40%. Gastric dysmotility leads to a delay in gastric emptying in patients with complications such as vomiting, aspiration and ventilator-associated pneumonia. There is no clarification of whether the GRV represents the value below which is suggested to advance feedings or the threshold value at which feedings should be discontinued due to potential gastrointestinal intolerance. Objective: The aim of this study is to compare GRV 200 mL and 400 mL effects on the time to reach the goal rate of feeding and gastrointestinal intolerance in patients which enteral nutrition is started and continued in intensive care unit. Material and Method: In this study, after non-invasive research ethics committee of Dokuz Eylül University approval, fifty-six patients which were mechanically ventilated, older than 18 and expected to stay more than 3 days in ICU and fed enterally with nasogastric tube were enrolled to the study. Patients were randomised into two groups as Group I GRV threshold 200 mL and Group II GRV 400 mL. Measurement of GRV was done at a 6-h interval. The feedings were started at 20 mL/h and were increased by 10 mL/h to the goal rate if tolerated. Results: For 3 days of follow up, there was no statistically significant difference comparing the GRV's, emesis, diarrhea or the total episodes of intolerance. The patients in group II reached their goal rates on average in 24 hours compared with 26 hours in Group I; however, these differences were not statistically significant. Conclusion: As a conclusion, in patients which enteral nutrition is started and continued there was no statistically significant difference between GRV threshold 200 mL and GRV threshold 400 mL groups to reach their goal rates and gastrointestinal complications. In intensive Care Unit a value of 400 ml can be equally recommended as a normal limit for GRV.