Original Title: Mesure des résidus gastriques lors de l’alimentation entérale chez les patients hospitalisés à l’unité des soins intensifs

Authors' objectives: Patients admitted to an intensive care unit (ICU) must be fed enterally due to their inability to consume food by mouth. It is common in these patients to observe events of gastrointestinal intolerance including pain, abdominal distension, vomiting, or diarrhea. A large gastric residual volume is generally considered an indicator of abnormal gastric emptying and may be associated with a risk of aspiration pneumonia during episodes of regurgitation or vomiting. Thus, in order to reduce the risk of vomiting and aspiration, gastric residual volume (GRV) is measured regularly throughout the duration of enteral feeding (EF). Currently, there is uncertainty in the scientific community regarding the best method to use and the relevance of GRV measurement. The Department of Intensive Care requested that the Health Technology Assessment Unit (HTAU) assess the relevance of revising their GRV measurement protocol.

Authors' results and conclusions: Analysis of the available evidence suggested that using GRV thresholds of up to 500 ml before stopping EF, or not measuring GRV, is associated with a slightly higher risk of vomiting. Among the studies that reported episodes of gastrointestinal intolerance, the results were mixed. Using a GRV threshold up to 500 ml, or no measurement of GRV, are not associated with a higher risk of pneumonia, diarrhea, increased length of stay in the ICU, number of days on mechanical ventilation, and mortality. The data reviewed in this report suggests that stopping EF upon reaching a threshold of 250 ml of GRV compared to not measuring the GRV could lead to a higher risk of caloric deficit. According to the environmental scan survey carried out among centres affiliated with the Integrated University Health and Social Services Network of Laval University, the protocols for measuring GRV were heterogeneous. Slightly more than half of respondents were of the opinion that this practice could be abandoned, or that it should not be used systematically.

Authors' recommendations: According to the current state of knowledge, the HTAU recommends that the Quebec Heart and Lung Institute – Laval University revise the method of care concerning the measurement of GRV during EF in patients hospitalized in the ICU to better target those who could benefit from it. It is also suggested to set up a working group whose mandate would be to revise the method of care by identifying the risk factors for gastrointestinal intolerance that would justify the measurement of GRV in patients hospitalized in the ICU.

Project Status: Completed

URL for project: https://iucpq.qc.ca/fr/institut/qualite-et-performance/evaluation-des-technologies-et-modes-d-intervention-en-sante-etmis/accueil

Year Published: 2019

URL for published report: https://iucpq.qc.ca/sites/default/files/rap_residus_gastriques_10-06.pdf

Requestor: Department of Intensive Care

English language abstract: There is no English language summary available

Publication Type: Full HTA

Country: Canada

Province: Quebec

Organisation Name: Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval (IUCPQ-ULaval)

Contact Address: 2725, chemin Sainte-Foy Québec QC G1V 4G5

Contact Name: uetmis.iucpq@ssss.gouv.qc.ca

Contact Email: uetmis.iucpq@ssss.gouv.qc.ca

Copyright: Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval