• Sumeet Reddy, Michael Bailey, Richard Beasley, Rinaldo Bellomo, Diane Mackle, Alex Psirides, and Paul Young.
• Medical Research Institute of New Zealand, Wellington, New Zealand. sumeetkreddy@gmail.com.
• Crit Care Resusc. 2016 Sep 1; 18 (3): 198-204.

ObjectiveTo compare the effect of Plasma-Lyte (PL)-148 and saline 0.9% (saline) on gastrointestinal (GI) feeding intolerance in mechanically ventilated patients receiving nasogastric (NG) feeding in an intensive care unit.Design And SettingA single-centre pilot study, nested within a multicentre, double-blind, cluster-randomised, double-crossover trial, performed in a mixed medical and surgical ICU.ParticipantsAll adult patients who required crystalloid fluid therapy as part of the 0.9% Saline versus Plasma-Lyte 148 for Intensive Care Unit Fluid Therapy (SPLIT) trial, were expected to need mechanical ventilation for more than 48 hours and were receiving enteral nutrition exclusively by NG tube were eligible. We enrolled 69 patients and assigned 35 to PL-148 and 34 to saline.InterventionsWe randomly allocated saline or PL-148 for four alternating 7-week blocks, with staff blinded to the solution.Main Outcome MeasuresThe primary outcome was the proportion of patients with GI feeding intolerance, defined as high gastric residual volume (GRV), diarrhoea or vomiting while receiving NG feeding in the ICU. The proportions of patients with each of high GRV, diarrhoea and vomiting were secondary outcomes.ResultsIn the PL-148 group, 21 of 35 patients (60.0%) developed GI feeding intolerance, compared with 22 of 34 patients (64.7%) in the saline group (odds ratio [OR], 0.82; 95% CI, 0.31-2.17; P = 0.69). A high GRV was seen in four of 35 patients (11.4%) in the PL-148 group, and in 11 of 34 patients (32.4%) in the saline group (OR, 0.27; 95% CI, 0.08-0.96; P = 0.04).ConclusionAmong mechanically ventilated patients receiving NG feeding, the use of PL-148, compared with saline, did not reduce the proportion of patients developing GI feeding intolerance, but was associated with a decreased incidence of high GRV.

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