Should We Stop Using Gastric Residual Volumes?

Abstract

Early enteral nutrition support is an important component in the management of critically ill patients. However, gastrointestinal tolerance and gastric motility are frequently impaired in this population. Intolerance of enteral nutrition may present clinically as vomiting, aspiration, and abdominal distension. Concerns for the association between gastrointestinal intolerance and the development of ventilator-associated pneumonia have historically led to close monitoring of patients’ tolerance of enteral feeding using various metrics. The measurement of gastric residual volumes (GRV) is the most commonly used surrogate marker for gastrointestinal intolerance in intensive care units. As the name implies, GRV is the volume of enteral formula remaining in a patient’s stomach after cessation of enteral nutrition at various, predetermined time intervals. Despite the logical rationale, there is increasing evidence that monitoring gastric residual volumes may not improve patient outcomes in the critically ill. In this review, we will describe the components of normal gastric motor physiology and review abnormal physiology and dysfunction observed during critical illness. Finally, we will examine the evidence that both supports and refutes the routine use of gastric residual volumes and suggest specific recommendations about the future utilization of this practice.