Effect of Eliminating Gastric Residual Volume Monitoring on Ventilator Associated Events
Study Details
Study Description
Brief Summary
The aims of this study are to investigate the effect of eliminating routine GRV monitoring on VAEs in patients receiving MV and early EF, Determine the effect of eliminating routine GRV monitoring on nutritional adequacy in patients receiving MV and early EF and evaluate the effect of eliminating routine GRV monitoring on feeding intolerance in patients receiving enteral feeding.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Early enteral nutrition (EN) is consistently recommended as first line nutrition therapy in critically ill patients since it favorably alters outcome, providing both nutrition and non-nutrition benefits. However, critically ill patients receiving mechanical ventilation (MV) are at risk for regurgitation, pulmonary aspiration, and eventually ventilator-associated pneumonia (VAP). EN may increase these risks when gastrointestinal (GI) dysfunction is present. Gastric residual volume (GRV) is considered a surrogate parameter of GI dysfunction during the progression of enteral feeding in the early phase of critical illness and beyond. About 62% of critically ill patients receive enteral nutrition (EN) and in patients on MV, enteral feeding was connected to a threefold increase in the development of VAP.
A new surveillance definition of ventilator-associated events (VAE) was introduced by the National Healthcare Safety Network (NHSN) in 2013 to identify patients who develop complications of MV. It outlines the various events in a step-by-step fashion, beginning with ventilator-associated complications (VAC), moving on to infectious complications (IVAC), and finally VAP. According to the NHSN, VAEs occur within 9% to 40% of mechanically ventilated patients
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: intervention groups Patients in the intervention group will not be monitored for GRV (no GRV monitoring) and will be evaluated for the presence of feeding intolerance indicators such as vomiting, regurgitation, and abdominal distention. |
Procedure: eliminating gastric residual volume monitoring
eliminating gastric residual volume monitoring from routine care
|
| No Intervention: control group Patients in the control group will be subjected to GRV monitoring (with GRV monitoring). |
Outcome Measures
Primary Outcome Measures
- eliminating gastric residual volume monitoring on ventilator associated events [3 month]
use centers for disease control and prevention (CDC) calculators for evaluating VAE version 9.0 2021
Secondary Outcome Measures
- eliminating gastric residual volume monitoring on nutritional adequacy [3 month]
evaluation daily caloric requirement by body mass index that calculated using the equation (Weight in kg /height in cm) 2
- eliminating gastric residual volume monitoring on incidence of feeding intolerance indicators [3 month]
evaluation of abdominal circumference, abdominal distension, bowel sounds, the episodes of vomiting and diarrhea
Eligibility Criteria
Criteria
Inclusion Criteria:
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Adults (agedā„18 years)
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Newly admitted mechanically ventilated patients who are attached to a mechanical ventilator for at least 48 hours.
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Starting enteral nutrition via a nasogastric tube within 36 hours after intubation.
Exclusion Criteria:
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Abdominal surgery within the past month.
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History of esophageal, duodenal, pancreatic, or gastric surgery.
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Bleeding from the esophagus, stomach, or bowel.
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Enteral nutrition via a jejunostomy or gastrostomy.
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Pregnancy
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Damanhour University
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
- Reignier J, Mercier E, Le Gouge A, Boulain T, Desachy A, Bellec F, Clavel M, Frat JP, Plantefeve G, Quenot JP, Lascarrou JB; Clinical Research in Intensive Care and Sepsis (CRICS) Group. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA. 2013 Jan 16;309(3):249-56. doi: 10.1001/jama.2012.196377.
- Wang Z, Ding W, Fang Q, Zhang L, Liu X, Tang Z. Effects of not monitoring gastric residual volume in intensive care patients: A meta-analysis. Int J Nurs Stud. 2019 Mar;91:86-93. doi: 10.1016/j.ijnurstu.2018.11.005. Epub 2019 Jan 3.
- Yasuda H, Kondo N, Yamamoto R, Asami S, Abe T, Tsujimoto H, Tsujimoto Y, Kataoka Y. Monitoring of gastric residual volume during enteral nutrition. Cochrane Database Syst Rev. 2021 Sep 27;9(9):CD013335. doi: 10.1002/14651858.CD013335.pub2.
- elimination GRV monitor on VAE