ABSTRACT
BACKGROUND: The control of gastric residual volume (GRV) is a common nursing intervention in intensive care; however the literature shows a wide variation in clinical practice regarding the management of GRV, potentially affecting patients' clinical outcomes. The aim of this study is to determine the effect of returning or discarding GRV, on gastric emptying delays and feeding, electrolyte and comfort outcomes in critically ill patients. METHOD: A randomised, prospective, clinical trial design was used to study 125 critically ill patients, assigned to the return or the discard group. Main outcome measure was delayed gastric emptying. Feeding outcomes were determined measuring intolerance indicators, feeding delays and feeding potential complications. Fluid and electrolyte measures included serum potassium, glycaemia control and fluid balance. Discomfort was identified by significant changes in vital signs. RESULTS: Patients in both groups presented similar mean GRV with no significant differences found (p=0.111), but participants in the intervention arm showed a lower incidence and severity of delayed gastric emptying episodes (p=0.001). No significant differences were found for the rest of outcome measurements, except for hyperglycaemia. CONCLUSIONS: The results of this study support the recommendation to reintroduce gastric content aspirated to improve GRV management without increasing the risk for potential complications.
Subject(s)
Critical Care/methods , Enteral Nutrition/methods , Enteral Nutrition/nursing , Intubation, Gastrointestinal/nursing , Algorithms , Analysis of Variance , Chi-Square Distribution , Clinical Nursing Research , Decision Trees , Enteral Nutrition/adverse effects , Enteral Nutrition/instrumentation , Equipment Failure , Female , Gastric Emptying , Humans , Hyperglycemia/etiology , Hyperkalemia/etiology , Male , Middle Aged , Nursing Assessment/methods , Prospective Studies , Respiratory Aspiration/etiology , Statistics, Nonparametric , Suction/methods , Suction/nursing , Treatment OutcomeABSTRACT
INTRODUCTION: Measurement of residual gastric volume is a frequent practice in chronic patients, but there is lack of consensus on the convenience of reintroducing or discarding aspirated gastric content (AGC). OBJECTIVE: Determine the grade of scientific evidence on the efficacy of two interventions -reintroduction/rejection- of AGC in chronic patients. MATERIAL AND METHODS: Systematic review of the evidence available on the convenience of reintroducing or discarding ACG. PROCEDURE: a) establishment of inclusion/exclusion criteria; b) determination of the search strategy (keywords and itineraries); c) dumping of databases: MEDLINE, CINAHL, CUIDEN, IME, SCIELO and COCHRANE. Search for indirect method and manual dumping of indexes; d) independent and contrasted critical reading, using the CASPe template; and e) contrast of critical analysis results. RESULTS: Search itineraries generate more than 800 references that once purged make it possible to select 54. After reading them, only 4 really focused on the questions related with the reintroduction/rejection of AGC: 2 revisions, 1 observational study and a random clinical trial with a small sample. Meta-analysis techniques could not be used due to the heterogeneity of these studies. Thus, the results of the study were analyzed separately. Using this procedure, a final result was obtained that showed a low grade of scientific evidence. CONCLUSIONS: There is limited scientific evidence on the convenience, safety and benefits of both interventions. It is difficult to establish a care protocol, so that we suggest performing an experimental study to establish the indications and contraindications of both interventions.
Subject(s)
Anthropometry , Bibliometrics , Gastrointestinal Contents , Gastroparesis/diagnosis , Stomach/anatomy & histology , Algorithms , Databases, Bibliographic , Evidence-Based Medicine , Gastric Emptying , Gastroparesis/pathology , Humans , MEDLINE , Organ SizeABSTRACT
Introducción. La determinación del volumen gástrico residual es una práctica frecuente en pacientes críticos, pero hay falta de consenso acerca de la conveniencia de reintroducir o desechar el contenido gástrico aspirado (CGA). Objetivo. Determinar el grado de evidencia científica acerca de la eficacia de 2 intervenciones reintroducción/rechazo del CGA en pacientes críticos. Material y métodos. Revisión sistemática de la evidencia disponible acerca de la conveniencia de reintroducir o desechar el CGA. Proceso: a) establecimiento de los criterios de inclusión/exclusión; b) determinación de la estrategia de búsqueda (palabras clave e itinerarios); c) vaciado de las bases de datos: MEDLINE, CINAHL, CUIDEN, IME, SCIELO y COCHRANE. Búsqueda por método indirecto y vaciado manual de índices; d) lectura crítica independiente y contrastada, utilizando la plantilla CASPe, y e) contraste de resultados del análisis crítico. Resultados. Los itinerarios de búsqueda generan más de 800 referencias que, una vez depuradas, permiten seleccionar 54. Después de su lectura, sólo 4 se centran realmente en cuestiones relacionadas con la reintroducción/rechazo del CGA: 2 revisiones, un estudio observacional y un ECA de muestra pequeña. La heterogeneidad de estos estudios no permite emplear técnicas de metaanálisis. Por ello se analizan por separado los resultados de cada estudio. Mediante este proceso se obtiene un resultado final que demuestra un bajo grado de evidencia científica. Conclusiones. Hay escasa evidencia científica acerca de la conveniencia, la seguridad y los beneficios de ambas intervenciones. Es difícil establecer un protocolo de cuidados, por lo que se planteó realizar un estudio experimental para establecer las indicaciones y contraindicaciones de ambas intervenciones
Introduction. Measurement of residual gastric volume is a frequent practice in chronic patients, but there is lack of consensus on the convenience of reintroducing or discarding aspirated gastric content (AGC). Objective. Determine the grade of scientific evidence on the efficacy of two interventions reintroduction/rejection of AGC in chronic patients. Material and methods. Systematic review of the evidence available on the convenience of reintroducing or discarding ACG. Procedure: a) establishment of inclusion/exclusion criteria; b) determination of the search strategy (keywords and itineraries); c) dumping of databases: MEDLINE, CINAHL, CUIDEN, IME, SCIELO and COCHRANE. Search for indirect method and manual dumping of indexes; d) independent and contrasted critical reading, using the CASPe template; and e) contrast of critical analysis results. Results. Search itineraries generate more than 800 references that once purged make it possible to select 54. After reading them, only 4 really focused on the questions related with the reintroduction/rejection of AGC: 2 revisions, 1 observational study and a random clinical trial with a small sample. Meta-analysis techniques could not be used due to the heterogeneity of these studies. Thus, the results of the study were analyzed separately. Using this procedure, a final result was obtained that showed a low grade of scientific evidence. Conclusions. There is limited scientific evidence on the convenience, safety and benefits of both interventions. It is difficult to establish a care protocol, so that we suggest performing an experimental study to establish the indications and contraindications of both interventions
