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. 2008 Nov;17(6):512-9; quiz 520.

Gastric residual volume and aspiration in critically ill patients receiving gastric feedings

Norma A Metheny  1 , Lynn Schallom, Dana A Oliver, Ray E Clouse
Affiliations

Gastric residual volume and aspiration in critically ill patients receiving gastric feedings

Norma A Metheny et al. Am J Crit Care. 2008 Nov.

Abstract

Background: The helpfulness of bedside assessment of gastric residual volume in the prediction of aspiration has been questioned, as has the volume that signals increased risk of aspiration.

Objective: To describe the association between gastric residual volumes and aspiration of gastric contents.

Methods: In a prospective study of 206 critically ill patients receiving gastric tube feedings for 3 consecutive days, gastric residual volumes were measured with 60-mL syringes every 4 hours. Measured volumes were categorized into 3 overlapping groups: at least 150 mL, at least 200 mL, and at least 250 mL. Patients were categorized as frequent aspirators if 40% or more of their tracheal secretions were positive for pepsin and as infrequent aspirators if less than 40% of their secretions were positive for pepsin. Gastric residual volumes were compared between the 2 aspiration groups.

Results: Approximately 39% of the 206 patients had 1 or more gastric residual volumes of at least 150 mL, 27% had 1 or more volumes of at least 200 mL, and 17% had 1 or more volumes of at least 250 mL. Large-bore tubes identified most of the high volumes. Eighty-nine patients were frequent aspirators. Volumes less than 150 mL were common in both aspiration groups. However, the frequent aspirators had a significantly greater frequency of 2 or more volumes of at least 200 mL and 1 or more volumes of at least 250 mL.

Conclusions: No consistent relationship was found between aspiration and gastric residual volumes. Although aspiration occurs without high gastric residual volumes, it occurs significantly more often when volumes are high.

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Figures

Figure 1
Figure 1
Median, upper and lower quartiles, and range of percentages of pepsin-positive tracheal secretions in the frequent and infrequent aspiration groups.
Figure 2
Figure 2
Frequency of high gastric residual volumes (N = 206)
Figure 3
Figure 3
Mean percentage of pepsin-positive tracheal secretions according to gastric residual volume. Data are from 3286 aspirates from small- and large-bore tubes. By 1-way analysis of variance, P < .001.
Figure 4
Figure 4
Distribution of gastric residual volume categories in frequent and infrequent aspirators (univariate analysis, χ2 analysis).
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