Effects of gastric residual volume set at different thresholds on intensive care patients receiving enteral nutrition: a systematic review

Abstract

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. Key words: Enteral nutrition; Intensive care units; Meta-analysis; Gastric residual volume; Complications