RESUMEN
Feeding intolerance is a common cause of enteral nutrition interruption, which has a high incidence in the pediatric intensive care unit.It seriously affects the nutritional management of critically ill children, affects the treatment effect of critically ill children, and can lead to serious complications and even death.There is a lack of standardized and unified standards for the assessment of feeding intolerance in clinical practice, and there is an urgent need for objective and standard assessment tools.Ultrasound is a non-invasive, simple and non-radiation clinical technique, which can be used to measure gastric residual volume at the bedside in critically ill children, and evaluate feeding intolerance.
RESUMEN
Gastric residual volume (GRV) has been widely used in clinical practice for a long time as an essential indicator of gastrointestinal motility and enteral nutrition tolerance. Recent studies have questioned the rationality of monitoring GRV routinely in critically ill patients. A "one size fits all" principle is not an optimal solution in the clinical practice of enteral nutrition in critically ill patients because of the huge heterogeneity of the intensive care unit (ICU) population. Each method of monitoring GRV has advantages and disadvantages. With the widespread clinical application of harmless monitoring technologies such as ultrasound, the gastric suctioning method maybe used less and less. The management of enteral nutrition focuses on identifying the factors and triggers of gastric retention, attempting to solve them from the perspective of prevention and elimination of high-risk factors for aspiration and analysis of pathophysiological mechanisms, eliminating all negative hindering factors, and actively promoting the concept of "creating conditions for enteral nutrition". As a critical nutrition management team, it is necessary to pay attention to the continuous improvement of enteral nutrition management culture and rationally use diversified management strategies, which may be more important than monitoring GRV.
RESUMEN
Objective@#To discuss the application of bedside ultrasound monitoring of gastric residual volume in ICU patients complicated with enteral nutrition support via nasogastric tube.@*Methods@#November 2017 to May 2018, 120 patients with enteral nutrition support via nasogastric tube who admitted in ICU of our hospital were randomly divided into the observation group and the control group. The observation group used bedside ultrasound monitoring to determine the gastric residual volume, while the control group was estimated by withdrawn with 50 ml syringe. Reflux, pulmonary aspiration and the time of enteral nutrition were observed in both groups.@*Results@#Reflux and pulmonary aspiration were present in 2, 3 in the observation group and 10, 11 in the control group, with significant difference between them (χ2=4.53, 3.96, P<0.05). The time of enteral nutrition in the observation group was (13.98±3.20) h, and (15.54±3.54) h in the control group, which had a statistically difference (t=-10.49, P<0.05).@*Conclusion@#The application of bedside ultrasound monitoring of gastric residual volume in ICU patients complicated with enteral nutrition support via nasogastric tube can significantly reduce the risk of reflux and pulmonary aspiration which can ensure the safety of enteral nutrition, and decrease time of enteral nutrition.
RESUMEN
OBJECTIVE: To observe the clinical therapeutic effect of acupuncture of Huatuo Jiaji (EX-B2) in the treatment of gastrointestinal dysfunction in sepsis patients, aiming at providing new clinical approach and evidence for improving septic gastrointestinal activity. METHODS: A total of 40 patients with septic gastrointestinal dysfunction who met our inclusive criteria were randomly divided into control group and treatment group (n＝20 cases in each). Patients in the control group received routine treatment of nasogastric mosapride citrate (5 mg/time, three times a day) and tifidobacterium triple viable capsules (420 mg, twice a day), intravenous infusion of omeprazole (40 mg, twice a day), rational dose of antibiotics, maintenance treatment of functions of the heart, lung, brain, kidney and other important organs and water electrolyte balance, as well as symptomatic treatment. Patients of the treatment group were treated by acupuncture of EX-B2 on the basis of routine treatment mentioned above in the control group. The acupuncture needle was inserted into EX-B2, twirled for a while and retained for 30 min, once a day for 10 successive days. The acute physiology and chronic health evaluation (APACHE II) score was given according to Knaus and colleagues' method, the intra-abdominal pressure was detected by using a manometer which was connected to an inserted canal in the urinary bladder, and the intragatric residul volume detected by using an injection syriange pumping via a nasal feeding tube. RESULTS: After the treatment, the APACHE II score, intra-abdominal pressure and intragastric residual volume on day 10 were significantly decreased in both groups in comparison with their own pre-treatment (P<0.05), while the borborygmus levels on day 10 were considerably increased in both groups relevant to their own pre-treatment (P<0.05). The APACHE II scores, intra-abdominal pressure and intragastric residual volume on day 3, 6 and 10 were significantly lower in the treatment group than those in the control group (P<0.05), whereas the borborygmus levels at the 3rd , 6th and 10th day in the treatment group were apparently higher than those of the control group (P<0.05)．. CONCLUSION: Acupuncture stimulation of EX-B2 has a good curative effect in improving gastrointestinal dysfunction in sepsis patients.
RESUMEN
Objective To evaluate the clinical implementation value of bedside ultrasound monitoring of gastric residual volume in the guidance of enteral nutrition (EN) in severe patients with mechanical ventilation. Methods One hundred and forty-three patients undergoing nasal feeding EN and mechanical ventilation ≥ 72 hours in the Department of Intensive Care Unit (ICU) of Jinhua People's Hospital from May 2017 to August 2018 were enrolled, and they were randomly divided into two groups: a traditional control group (71 cases) and an ultrasound monitoring group (72 cases). The traditional control group applied 50 mL syringe to withdraw gastric juice from gastric tube, once every 4 hours, and then the EN protocol based on the gastric residual volume was adjusted; the ultrasound monitoring group used bedside ultrasound to monitor the gastric residual volume once every 4 hours, and then the EN protocol was adjusted accordingly. The changes of EN tolerance indexes e.g. abdominal distension, reflux vomiting, diarrhea, bowel sound hyperactivity or disappearance, intra-abdominal pressure, etc, the changes of incidence of ventilator-associated pneumonia (VAP), mechanical ventilation time and ICU hospitalization time in these two groups were observed. Results The incidences of abdominal distension, reflux vomiting, diarrhea, intestinal hyperactivity or disappearance of bowel sounds were significantly lower in the ultrasound monitoring group than those in the traditional control group [abdominal distension: 23.6% (17/72) vs. 28.2% (20/71), reflux vomiting: 18.1% (13/72) vs. 22.5% (16/71), diarrhea: 13.9% (10/72) vs. 14.1% (10/71), bowel sounds hyperactivity or disappearance: 9.7% (7/72) vs. 11.3% (8/71), all P < 0.05], the intra-abdominal pressure was obviously lower in the ultrasound monitoring group than that in the traditional control group [mmHg (1 mmHg = 0.133 kPa): 8.9±5.6 vs. 9.6±6.1, P < 0.05], and the incidence of VAP was significantly lower in the ultrasound monitoring group than that in the traditional control group [19.7% (14/72) vs. 23.9% (17/71), P < 0.05], the mechanical ventilation time and ICU hospitalization time were also significantly shorter in the ultrasound monitoring group than those in the traditional control group [mechanical ventilation time (days): 10.1±3.1 vs. 12.2±3.4, ICU hospitalization time (days): 16.8±4.2 vs. 20.6±4.8, all P < 0.05]. Conclusion The bedside ultrasound monitoring gastric residual volume can improve EN tolerance, reduce VAP incidence, and shorten the mechanical ventilation time and ICU hospitalization time in patients with mechanical ventilation.
RESUMEN
Objective@#To evaluate the feeding effect of not monitoring gastric residual volume in ICU patients receiving continuous enteral feeding,including complications and calorie intake.@*Methods@#We searched for relevant studies in China national knowledge internet(CNKI), Wanfang Data, PubMed, Embase, Cochrane library. We included all Randomized controlled trials (RCTs) and pre-post studies related to the feeding effect of not monitoring gastric residual volume in ICU patients receiving continuous enteral feeding. Two researchers independently screened, appraised and extracted data, and meta-analysis was conducted via RevMan 5.3 software.@*Results@#3 RCTs and 2 pre-post studies with 1 000 patients were included. Not monitoring gastric residual volume increase the rate of vomiting [OR=1.35, 95%CI(1.02, 1.80), Z=2.08, P=0.04], decrease the proportion of intolerance to enteral nutrition [OR=0.35, 95%CI(0.26, 0.46), Z=7.29, P<0.01], there were no significant differences in diarrhea [OR=1.14, 95%CI(0.78, 1.67), Z=0.67, P=0.51] and distention[OR=1.24, 95%CI(0.76, 2.03), Z=0.87, P=0.38]. The cumulative calorie deficit between targeted volume and provided volume in not monitoring gastric residual volume group was significantly lower than the control group[MD=-0.29, 95%CI(-0.47, -0.11), Z=3.23, P=0.001], daily provided calorie amount was also significantly higher than the control group [MD=0.35, 95%CI(0.10, 0.59), Z=2.75, P=0.006].@*Conclusions@#Not monitoring gastric residual volume in ICU patients increase calorie intake and have better enteral nutrition provision, decrease the proportion of intolerance to enteral nutrition. Monitoring gastric residual volume should not be taken as a routine task in critical care nursing.
RESUMEN
Objective To discuss the application of bedside ultrasound monitoring of gastric residual volume in ICU patients complicated with enteral nutrition support via nasogastric tube. Methods November 2017 to May 2018, 120 patients with enteral nutrition support via nasogastric tube who admitted in ICU of our hospital were randomly divided into the observation group and the control group. The observation group used bedside ultrasound monitoring to determine the gastric residual volume, while the control group was estimated by withdrawn with 50 ml syringe. Reflux, pulmonary aspiration and the time of enteral nutrition were observed in both groups. Results Reflux and pulmonary aspiration were present in 2, 3 in the observation group and 10, 11 in the control group, with significant difference between them (χ2=4.53, 3.96, P<0.05). The time of enteral nutrition in the observation group was (13.98±3.20) h, and (15.54 ± 3.54) h in the control group, which had a statistically difference (t =-10.49, P<0.05). Conclusion The application of bedside ultrasound monitoring of gastric residual volume in ICU patients complicated with enteral nutrition support via nasogastric tube can significantly reduce the risk of reflux and pulmonary aspiration which can ensure the safety of enteral nutrition, and decrease time of enteral nutrition.
RESUMEN
Objective To compare the effects of gastric residual volume (GRV) set at different thresholds on intensive care patients receiving enteral nutrition (EN),so as to inform clinical practice.Methods Controlled clinical trials involving different GRV thresholds in ICU patients undergoing EN were retrieved from multiple electronic databases (including Cochrane Library,PubMed,Ovid Medline,Web of Science,CBM,CNKI,Wanfang Data,and VIP).Quality of the retrieved studies was evaluated for data extraction,and meta-analysis was performed.Results Four randomized controlled trials and one clinically controlled trial were included in the study,with a total of 658 subjects.Results of the meta-analysis suggested no statistically significant difference between the group with GRV threshold≥250 ml and the one with GRV threshold＜250 ml in the rates of pneumonia (OR =1.19,95％ CI =0.77-1.82,P =0.43),aspiration.(OR =1.59,95％ CI =0.42-6.03,P=0.50),vomiting (OR=1.35,95％ CI=0.48-3.80,P=0.57),reflux (OR=1.29,95％ CI=0.58-2.88,P=0.53),and diarrhea (OR=1.36,95％ CI=0.87-2.13,P=0.17).Nutrient intake and several other outcome measures were unable to be included in the meta-analysis for either the scarcity of studies or inconsistency in the measures adopted,and descriptive analysis was therefore employed instead.Conclusion There was no significant difference between the two groups in terms of complications,but the group with GRV threshold≥250 ml had higher intake of EN.
RESUMEN
Objective:To investigate the effect of bedside ultrasound in measuring the gastric residual volume in postoperative patients with rheumatic heart disease complicated with cachexia with enteral nutrition support.Method:From June 2015 to May 2017,60 patients with rheumatic heart disease complicated with cachexia who admitted in ICU were randomly divided into two groups,group A (routine enteral nutrition plan plus ultrasound monitoring GRV)and group B (routine enteral nutrition plan plus withdraw every 4h to monitor the GRV),to guide the implementation of enteral nutrition.Results:There was significant difference in Hb,TP and ALB levels between the two groups (P ＜0.05).The nutritional status of group A was better than that of group B.The incidence of gastric retention and pulmonary infection in group A was significant lower than group B (P ＜0.05).The length of target feeding time and ICU stay had a statistically difference in group A and group B [(3.02 ± 0.78) d vs (4.89 ± 0.69) d,t=2.278,P=0.019] and [(10.41 ± 1.98) d vs (11.39 ± 1.75) d,t=2.384,P=0.015].Conclusion:The application of bedside ultrasound to monitor the gastric residual volume can be an accurate method to guide enteral nutrition in postoperative patients with rheumatic heart disease complicated with cachexia,which can improve the nutrition status,shorten the length of target feeding time and ICU stay and reduce enteral nutrition-related complications.
RESUMEN
Clinicians monitor the gastric residual volume(GRV) of critical ill patients to minimize or prevent side effect of EN.Nevertheless,recommendations about the threshold GRV in critically ill patients treated with EN are not uniform.Many recent clinical studies had demonstrated that increasing the limit of GRV was associated with the increase in the diet volume ratio of ICU patients receiving EN,and it was not associated with adverse effects in gastrointestinal complications.This review summarizes the influence factors of GRV monitoring to evaluate the feasibility and necessity of increasing the threshold of GRV.
RESUMEN
Objective To explore the difference in gastric residual volume (GRV) between singledose and split-dose bowel preparation before colonoscopy under general anesthesia.Methods From October 8th to December 30th in 2016,the out-patients undergoing gastroscopy and colonoscopy with anesthesia services on the same day were selected and divided into the traditional single-dose bowel preparation group and split-dose bowel preparation group.The GRV and intestinal preparation quality were compared between the two groups.T test was used for statistical analysis and multiple linear regression analysis was performed for the influence factors of GRV analysis.Results A total of 121 patients were enrolled,60 patients in the spilt-dose bowel preparation group and 61 in the traditional single-dose bowel preparation group.The mean GRV of the split-dose bowel preparation group was (17.3 ± 12.2) mL,which was lower than that of the single-dose bowel preparation group ((23.7 ± 14.6) mL),and the difference was statistically significant (t =2.642,P=0.009).The score of intestinal preparation quality of the split-dose bowel preparation group was 8.05 ± 0.85,which was higher than that of the single-dose bowel preparation group (7.67±1.19),and the difference was statistically significant (t =-2.002,P=0.048).Fasting time was related with GRV (odd ratios (OR)=1.732,95％ contidence interval (CI) O.299 to 3.168,P=0.018).Conclusion The GRV of patients with split-dose bowel preparation before colonoscopy is lower than that of traditional single-dose bowel preparation,thus reducing the risk of aspiration during anesthesia.
RESUMEN
To investigate the accuracy and feasibility of Brix value on monitoring gastric residual volume (GRV) in patients with enteral nutrition. Fifty patients with enteral nutrition via nasogastric tube were enrolled. The GRV was measured by both ultrasonography and Brix value. The results were compared according to the methods. The Pearson correlation coefficients showed that GRV measured by these two ways was positively correlated (r=0.986, P<0.05). Moreover paired sample t-test showed that the discrepancy was not statistically significant (P>0.05) between different measurements. The consistency was analyzed by Bland-Altman graph, showing that the two measurements were consistent. Brix value is recommended to measure GRV due to its convenience and easy operation.