Effects of ultrasound monitoring of gastric residual volume on feeding complications,caloric intake and prognosis of patients with severe mechanical ventilation

BACKGROUND Monitoring of gastric residual is an important approach for assessing gastric emptying in patients with mechanical ventilation.By monitoring gastric contents,the enteral nutrition scheme can be adjusted in time to ensure feeding safety.AIM To investigate the effects of ultrasound monitoring on the incidence of feeding complications,daily caloric intake and prognosis of patients with severe mechanical ventilation.To analyze the clinical significance of ultrasound monitoring of gastric residual volume(GRV)up to 250 mL to provide a theoretical basis for clinical practice.METHODS Patients admitted to the department of emergency medicine of the Affiliated Hospital of Nantong University from January 2018 to June 2022 who received invasive mechanical ventilation and continuous enteral nutrition support within 24-48 h after admission were enrolled in this study.Medical records for patients within 7 d of hospitalization were retrospectively analyzed to compare the incidence of feeding complications,daily caloric intake and clinical prognosis between patients with gastric residual≥250 mL and<250 mL,as monitored by ultrasound on the third day.RESULTS A total of 513 patients were enrolled in this study.Incidences of abdominal distension,diarrhea,and vomiting in the<250 mL and≥250 mL groups were:18.4%vs 21.0%,23.9%vs 32.3%and 4.0%vs 6.5%,respectively;mortality rates were 20.8%vs 22.65%;mechanical ventilation durations were 18.30 d vs 17.56 d while lengths of stay in the intensive care units(ICU)were 19.87 d vs 19.19±5.19 d.Differences in the above factors between groups were not significant.Gastric residual≥250 mL was not an independent risk factor for death and prolonged ICU stay.However,target feeding time of patients in the≥250 mL group was longer than that of patients in the≥250 mL group,and caloric intake(22.0,23.6,24.8,25.3 kcal/kg/d)for patients in the≥250 mL group from the 4^(th) day to the 7^(th) day of hospitalization was lower than that of patients in the≥250 mL group(23.2,24.8,25.7,25.8 kcal/kg/d).On the 4^(th) day(Z=4.324,P=0.013),on the 5^(th) day(Z=3.376,P=0.033),while on the 6^(th) day(Z=3.098,P=0.04),the differences were statistically significant.CONCLUSION The use of ultrasound to monitor GRV and undertaking clinical interventions when the monitoring value is≥250 mL has no significant effects on incidences of feeding complications and clinical prognostic outcomes,however,it significantly prolongs the time to reach target feeding,reduces the daily intake of calories during ICU hospitalization,and increases the risk of insufficient nutrition of patients.The accuracy and necessity of monitoring gastric remnants and monitoring frequencies should be investigated further.

Effect of percutaneous endoscopic gastrostomy on gastroesophageal reflux in mechanically-ventilated patients

AIM： To investigate the effect of percutaneous endoscopic gastrostomy （PEG） on gastroesophageal reflux （GER） in mechanically-ventilated patients. METHODS ： In a prospective, randomized, controlled study 36 patients with recurrent or persistent ventilatorassociated pneumonia （VAP） and GER 〉 6% were divided into PEG group （n=16） or non-PEG group （n = 20）. Another 11 ventilated patients without reflux （GER 〈 3%） served as control group. Esophageal pH-metry was performed by the ＂pull through＂ method at baseline, 2 and 7 d after PEG. Patients were strictly followed up for semi-recumbent position and control of gastric nutrient residue. RESULTS： A significant decrease of median （range） reflux was observed in PEG group from 7.8 （6.2-15.6） at baseline to 2.7 （0-10.4） on d 7 post-gastrostomy （P 〈 0.01）, while the reflux increased from 9 （6.2-22） to 10.8 （6.3-36.6） （P〈 0.01） in non-PEG group. A significant correlation between GER （%） and the stay of nasogastric tube was detected （r= 0.56, P〈 0.01）. CONCLUSION： Gastrostomy when combined with semi- recumbent position and absence of nutrient gastric residue reduces the gastroesophageal reflux in ventilated patients.