CARING FOR THE CRITICALLY ILL PATIENT EffectofNotMonitoringResidualGastricVolume on Risk of Ventilator-Associated Pneumonia in Adults Receiving Mechanical Ventilation and Early Enteral Feeding A Randomized Controlled Trial

EARLY ENTERAL NUTRITION IS THE standard of care in critically ill patients receiving invasive mechanical ventilation. However, numerous studies have shown that early enteral nutrition is frequently not used or associated with inadequate calorie delivery. The main reason for nonuse is gastrointestinal intolerance to enteral nutrition, which has been ascribed to gastroparesis with increased gastric volume, gastroesophageal reflux, and regurgitation or vomiting carrying a risk of aspiration and ventilator-associated pneumonia (VAP). This theoretical sequence has prompted a recommendation to monitor the residual gastric volume of mechanically ventilated patients receiving early enteral nutrition. When the residual gastric volume exceeds a predetermined cutoff, gastric prokinetic drugs are given and enteral nutrition is decreased or stopped to minimize the risk of aspiration and subsequent VAP. For editorial comment see p 283. Author Affiliations and a List of the CRICS Group appear at the end of the article. Corresponding Author: Jean Reignier, MD, PhD, Service de Reanimation, Centre Hospitalier Departemental de la Vendee, 85000 La Roche-sur-Yon, France ( [email protected]). Caring for the Critically Ill Patient Section Editor: Derek C. Angus, MD, MPH, Contributing Editor, JAMA ([email protected]). Importance Monitoring of residual gastric volume is recommended to prevent ventilator-associated pneumonia (VAP) in patients receiving early enteral nutrition. However, studies have challenged the reliability and effectiveness of this measure.