Measuring gastric residual volumes in critically ill burn patients - A systematic review

C H Pham; Z J Collier; W L Garner; C M Kuza; T J Gillenwater

doi:10.1016/j.burns.2018.05.011

Measuring gastric residual volumes in critically ill burn patients - A systematic review

Burns. 2019 May;45(3):509-525. doi: 10.1016/j.burns.2018.05.011. Epub 2018 Jun 18.

Authors

C H Pham¹, Z J Collier², W L Garner³, C M Kuza⁴, T J Gillenwater⁵

Affiliations

¹ Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, United States.
² Division of Plastic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, CA 90033, United States.
³ Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, United States; Division of Plastic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, CA 90033, United States.
⁴ Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, United States; Department of Anesthesiology and Critical Care, Keck School of Medicine, University of Southern California, 1520 San Pablo St, Suite 3451, Los Angeles, CA 90033, United States.
⁵ Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, United States; Division of Plastic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, CA 90033, United States. Electronic address: [email protected].

PMID: 29914737
DOI: 10.1016/j.burns.2018.05.011

Abstract

Purpose: Measuring gastric residual volumes (GRV) is common in intensive care units (ICU) in patients receiving enteral nutrition (EN) and are a common source of feeding interruptions. Interruptions in EN yield adverse outcomes and are an area of improvement in burn care. The objectives of this study are to summarize the literature's ICU GRV practices and offer practical suggestions to GRV management in the burn patient.

Methods: PubMed, SCOPUS, and OvidSP Medline were systematically reviewed using the keywords: burns; thermal injury; gastric residual volume; enteral feeding; tube feeding; enteral nutrition; gastric intolerance; ICU; critical illness. Reviews, case reports, and consensus and opinion papers were excluded.

Results: 26 articles were identified. Six burn-specific studies were identified. GRV practices vary widely and are a common cause of EN interruption. Elevated GRVs do not equate to gastrointestinal intolerance and do not always reflect aspiration risk.

Conclusions: We advocate a GRV threshold of 500mL should be used to optimize the benefits of EN in burn ICUs. A single incident of elevated GRVs should not mandate immediate EN rate reduction or cessation but should prompt a thoughtful examination of secondary causes of gastrointestinal intolerance. Randomized controlled trials are needed to define the ideal GRV threshold and re-evaluate its role in burn care.

Keywords: Burns; Critical care; Gastric residual volume; Plastic surgery; Thermal injuries.

Publication types

Systematic Review

MeSH terms

Burns / therapy*
Critical Care
Critical Illness
Enteral Nutrition / methods*
Gastric Emptying*
Humans
Intensive Care Units
Respiratory Aspiration / epidemiology*
Stomach*