Gastric residual volume monitoring practices in UK intensive care units: a web-based survey
Gastric residual volume monitoring practices in UK intensive care units: a web-based survey
Background and aim: Monitoring of gastric residual volume (GRV) to assess for enteral feeding intolerance is common practice in the intensive care unit (ICU) setting; however, evidence to support the practice is lacking. The aim of this study was: (i) to gain a perspective of current practice in adult ICUs in the UK around enteral feeding and monitoring of GRV, (ii) to characterise the threshold value used for a high GRV in clinical practice, (iii) to describe the impact of GRV monitoring on enteral feeding provision and (iv) to inform future research into the clinical value of GRV measurement in the adult ICU population. Methods: A web-based survey was sent to all UK adult ICUs. The survey consisted of questions pertaining to (i) nutritional assessment and enteral feeding practices, (ii) enteral feeding intolerance and GRV monitoring and (iii) management of raised GRV. Results: Responses were received from 101 units. Ninety-eight percent of units reported routinely measuring GRV, with 86% of ICUs using GRV to define enteral feeding intolerance. Threshold values for a high GRV varied from 200 to 1000 ml with frequency of measurement also differing greatly from 2 to 12 hourly. Initiation of pro-kinetic medication was the most common treatment for a high GRV. Fifty-two percent of respondents stated that volume of GRV would influence their decision to stop enteral feeds a lot or very much. Only 28% of units stated that they had guidelines for the technique for monitoring GRV. Conclusions: Measurement of GRV is the most common method of determining enteral feeding intolerance in adult ICUs in the UK. The practice continues despite evidence of poor validity and reproducibility of this measurement. Further research should be undertaken into the benefit of ongoing GRV measurements in the adult ICU population and alternative markers of enteral feeding intolerance.
Enteral feeding, critically ill, gastric residual volumes, tolerance
Jenkins, Bethan
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Calder, Philip
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Marino, Luise
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Jenkins, Bethan
ed7a7ed9-8725-424e-86df-efc1f81d5aba
Calder, Philip
1797e54f-378e-4dcb-80a4-3e30018f07a6
Marino, Luise
c479400f-9424-4879-9ca6-d81e6351de26
Jenkins, Bethan, Calder, Philip and Marino, Luise
(2023)
Gastric residual volume monitoring practices in UK intensive care units: a web-based survey.
Journal of the Intensive Care Society.
(doi:10.1177/17511437231210483).
Abstract
Background and aim: Monitoring of gastric residual volume (GRV) to assess for enteral feeding intolerance is common practice in the intensive care unit (ICU) setting; however, evidence to support the practice is lacking. The aim of this study was: (i) to gain a perspective of current practice in adult ICUs in the UK around enteral feeding and monitoring of GRV, (ii) to characterise the threshold value used for a high GRV in clinical practice, (iii) to describe the impact of GRV monitoring on enteral feeding provision and (iv) to inform future research into the clinical value of GRV measurement in the adult ICU population. Methods: A web-based survey was sent to all UK adult ICUs. The survey consisted of questions pertaining to (i) nutritional assessment and enteral feeding practices, (ii) enteral feeding intolerance and GRV monitoring and (iii) management of raised GRV. Results: Responses were received from 101 units. Ninety-eight percent of units reported routinely measuring GRV, with 86% of ICUs using GRV to define enteral feeding intolerance. Threshold values for a high GRV varied from 200 to 1000 ml with frequency of measurement also differing greatly from 2 to 12 hourly. Initiation of pro-kinetic medication was the most common treatment for a high GRV. Fifty-two percent of respondents stated that volume of GRV would influence their decision to stop enteral feeds a lot or very much. Only 28% of units stated that they had guidelines for the technique for monitoring GRV. Conclusions: Measurement of GRV is the most common method of determining enteral feeding intolerance in adult ICUs in the UK. The practice continues despite evidence of poor validity and reproducibility of this measurement. Further research should be undertaken into the benefit of ongoing GRV measurements in the adult ICU population and alternative markers of enteral feeding intolerance.
Text
GRV Monitoring Practices in UK ICU_review 3_no track change
- Accepted Manuscript
More information
Accepted/In Press date: 26 September 2023
e-pub ahead of print date: 20 November 2023
Additional Information:
Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Bethan Jenkins, Pre-Doctoral Clinical Academic Fellow (NIHR301168) is funded by Health Education England (HEE)/National Institute for Health Research (NIHR) for this research project. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS or the UK Department of Health and Social Care. Luise Marino is supported by the Research Leaders Programme, Southampton Academy of Research, University Hospital Southampton NHS Foundation Trust.
Publisher Copyright:
© The Intensive Care Society 2023.
Keywords:
Enteral feeding, critically ill, gastric residual volumes, tolerance
Identifiers
Local EPrints ID: 483007
URI: http://eprints.soton.ac.uk/id/eprint/483007
ISSN: 1751-1437
PURE UUID: f3e2e3f9-5ca8-4dd4-be9f-17240fc5037b
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Date deposited: 19 Oct 2023 16:35
Last modified: 18 Mar 2024 02:41
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Author:
Bethan Jenkins
Author:
Luise Marino
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