Management of the gastric residual volume in patients with enteral feeding in the intensive care unit

This study was conducted to find the biochemical effect of return or discard the gastric residual volume that had been aspirated back to the patient. The study continued until the desired number of patients was reached, in Aegean Medical Faculty, Neurosurgery Intensive Care Unit, during the period between September 21, 2013 and July 20, 2014. The sample of the study is found of three groups; who had just begun to be fed enterally with nasogastric tube and conformed to the limitations of research, the first group, the second group and the control groups included 30 patients as well, making the total number 90 patients. The study was designed as a randomised controlled study, the first and second groups provided the main data for the study, and the control group provided the necessary steps for a randomised controlled study. For data collection, the case follow-up questionnaire which was developed based on the literature and the gastric residue measurement protocol was used. The patients in the first and second groups were fed according to the algorithm based on the gastric residual volume management, and the patients in the control group were fed according to the routine practice ongoing in the clinic where the study was conducted continually and observed for 7 days. When the total number of calories planned for each patient was reached, the gastric residual volume check was applied in 6 hours periods. Only 250 ml of the gastric residue aspirated were given back to the patients in the first group. The gastric residual volume aspirated from the patients belonging to the second group were discharged. No gastric residual volume check was applied to the patients belonging to the control group. At the beginning of the study and at the 7th day of the study the blood levels of AST, ALT, CRP, prealbumine, cholesterol, transferrine, triglicerids, hemoglobine, hemotocrite, urea, creatinine, sodium, potassium, calcium, chloride, magnesium, phosphorus and glucose leveles were checked. And at the 4th day of the study urea, creatinine, sodium, potassium, calcium, chloride, magnesium, phosphorus and glucose levels were controlled. Shapiro-Wilk Test, Oneway-Anova Test, Boferroni Test, Kruskal-Wallis Test, Wilcoxon-Rank Test, Mann-Whitney Test and Chi-square Test was used to analyse the data. According to the results gained from the study, the systolic blood pressure and pulse rates did not differ before or after the gastric residue check (p<0.05), but the diastolic pressures and the temperature values differ (p<0.05). On the dates when the biochemical tests were run no difference was found in the amount of the nutrition received by the patients or in the balance of liquid among the three groups (p<0.05). No statistically significant difference among the volumes of gastric residual volume aspirated from the patients in three groups was detected (p>0.05). There were no statistically significant difference in AST, ALT, CRP, prealbumine, transferrine, cholesterole, hemoglobine, hemotocrite, urea, creatinine, sodium, potassium, calcium, chloride, magnesium and glucose levels (p>0.05), but the levels of triglycerides and phosphorus varied significantly among three groups. No difference was noted considering gastrointestinal tract complications such as vomiting, diarrhea, distension and constipation among the three groups (p>0.05). In the light of this study, it is advised to give the aspirated gastric outcome back to the patient in order to support gastric liquid and the electrolyte balance of the patient.