• Arie Soroksky, Jonathan Lorber, Elieser Klinowski, Eduard Ilgayev, Avraham Mizrachi, Asaf Miller, Tal Man Ben Yehuda, and Yuval Leonov.
• General Intensive Care Unit, Assaf Harofeh Medical Center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel. soroksky@gmail.com
• Isr Med Assoc J. 2010 Sep 1;12(9):543-8.

BackgroundEnteral nutrition in the critically ill patient is often complicated by gastrointestinal intolerance, manifested by a large gastric residual volume. The frequency of GRV assessment and the intolerant level above which feeding is stopped is controversial.ObjectivesTo evaluate a novel approach to EN by allowing high GRV and once-daily assessment that was correlated with the paracetamol absorption test.MethodsWe conducted a pilot prospective study in an 18 bed general intensive care unit. The study group comprised 52 consecutive critically ill mechanically ventilated patients. Enteral nutrition was started at full delivery rate. Once-daily assessment of GRV with three consecutively repeated threshold volumes of 500 ml was performed before stopping EN. The paracetamol absorption test was performed and correlated to GRV. Patients were divided into two groups: low GRV (< 500 ml) and high GRV (at least one measurement of GRV > 500 ml). Clinical outcome included maximal calories delivered, incidence of pneumonia, ICU length of stay, and ICU and hospital mortality.ResultsThere were 4 patients (9.5%) with ventilator-associated pneumonia in the low GRV group and 3 (30%) in the high GRV group (P = 0.12). GRV was inversely correlated to paracetamol absorption; however, neither GRV nor paracetamol absorption was associated with the development of pneumonia. Both groups had similar ICU length of stay (11.0 +/- 8.2 vs. 13.8 +/- 14.4 days, P = 0.41), and similar ICU (21% vs. 40%, P = 0.24) and hospital mortality (35% vs. 40%, P = 1.0).ConclusionsIn critically ill mechanically ventilated patients, allowing larger gastric residual volumes, measured once daily, enables enteral feeding with fewer interruptions which results in high calorie intake without significant complications or side effects.

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