Study of Impact of Not Measuring Residual Gastric Volume on Nosocomial Pneumonia Rates (NUTRIREA1)

Centre Hospitalier Departemental Vendee

Status

Completed

Conditions

Ventilation-Associated Pneumonia

Treatments

Procedure: not monitoring of residual gastric volume

Procedure: monitoring of residual gastric volume

Study type

Interventional

Funder types

Other

Identifiers

NCT01137487

NUTRIREA1

Details and patient eligibility

About

Early enteral feeding is a key component of the management of critically ill patients receiving mechanical ventilation. However, enteral feeding has been associated with serious complications such as aspiration followed by ventilator-associated pneumonia (VAP). Many critically ill patients experience poor tolerance of early enteral nutrition because of impaired gastric motility, which leads to a sequence of delayed gastric emptying, increased gastric volume, gastroesophageal reflux, vomiting, aspiration, and VAP. Routine monitoring of residual gastric volume (RGV) to minimize the risk of aspiration is standard practice. RGV is assumed to reflect gastric content, with high RGVs indicating impaired gastric emptying that requires discontinuation of enteral feeding in order to prevent aspiration.However, RGV measurement is neither standardized nor validated. The cut-off value that may indicate an increased risk of aspiration and therefore a need for discontinuing enteral feeding has not been determined, and cut-offs used in studies have ranged from 150 to 500 ml. No data are available to support a correlation between RGV and the rates of adverse events. In experimental studies, RGV failed to correlate with vomiting, aspiration, or VAP. The investigators hypothesize that RGV monitoring fails to decrease the risk of VAP and leed to inappropriate interruptions in enteral feeding with a risk of underfeeding. To assess the effects of not measuring RGV on VAP and enteral feeding delivery, the investigators designed a prospective randomized controlled study.

Enrollment

452 patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Treatment with invasive mechanical ventilation
Feeding via nasogastric tube within 36 hours after the initiation of endotracheal mechanical ventilation.
Age over 18 years
Informed consent

Exclusion criteria

Mechanical ventilation started more than 36 hours before institution of enteral feeding
Patients turned in the prone position at inclusion
Abdominal surgery within 1 month before inclusion
History of esophageal or gastric surgery
EN via a gastrostomy or a jejunostomy
Bleeding from esophagus, stomach or bowel
Moribund patient
Age less than 18 years
Pregnancy.
No informed consent.