Characteristics of ICU Patients on Enteral Nutrition According to the Gastric Residual Volume

Yu, Soyoung; Kim, Eun Mee; Cho, Young Y; Rha, Miyong; Kim, Jin Young; Chang, Dong Kyung; Seo, Jeong Meen

Abstract

PURPOSE
A high gastric residual volume (GRV) occurs early and frequently in patients who are receiving nasogastric tube feeding in the intensive care unit (ICU). This study analyzed the clinical and nutritional characteristics of ICU patients who received nasogastric tube feeding according to the GRV.
METHODS
The subjects were 76 patients who were admitted to the ICU at S Medical Center from January, 2009 to May, 2009 and who received enteral nutrition (EN) support. Tube feeding was skipped when the GRV was over 50~100 cc. The patients who experienced meal skipping due to high GRVs comprised the GRV group, and the patients whose feeding was never skipped due to high GRVs comprised the non-GRV group. The general, clinical and nutritional characteristics were determined at the beginning of the EN support, and the method of EN was collected for the first 3 days of tube feeding.
RESULTS
Nine patients experienced meal skipping due to GRV. There were no significant differences between the GRV and NGRV group in terms of age (60.4 vs. 61.8 years for GRV and NGRV, respectively; same respective order hereafter), pre-npo (5.0 vs. 4.7 days) and the ICU stay (20.5 vs. 23.7 days). Significant differences were evident in the GRV group concerning the ratio of male patients (55.2% vs. 88.9%; P<0.05), the medical-ICU patients (35.8% vs. 88.9%; P<0.05) and the sedated patients (29.8% vs. 66.7%; P<0.05). The BMI (22.4 vs. 21.8 kg/m2) and TLC (2,252 vs. 1,137 cells/mm3) values were not significantly different between the two groups. The serum albumin level (3.1 vs. 2.6 g/dl) was significantly lower in the GRV group (P<0.05) and the C-reactive protein level (8.11 vs. 19.02 mg/dl) and the ratio of moderately and severely malnourished patients (25.4% and 77.8%) was significantly higher in the GRV group (P<0.05). The mean feeding volume (731 vs. 688 cc) and ratio of the feeding rate (129 vs. 127 ml/h) during the first 3 days on EN was not significantly different between the two groups, nor was the required/maximum feeding volume (9.8 vs. 8.2 days).
CONCLUSION
In the GRV group, the ratio of male to sedated patients was significantly higher than that in the other group. The ratio of moderately and severely malnourished patients was also significantly higher in the GRV group. There were no significant differences in the methods of EN support.