CAT Critically Appraised Topic . Ashley Maas SN, Jamie Siewert SN, Erica Wills SN Carroll University, Waukesha WI Collaborating ICU Practice Council Member: Pauline flood, BSN, RN Waukesha Memorial Hospital, Waukesha, WI.
Critically Appraised Topic
Ashley Maas SN, Jamie Siewert SN, Erica Wills SN
Carroll University, Waukesha WI
Collaborating ICU Practice Council Member: Pauline flood, BSN, RN
Waukesha Memorial Hospital, Waukesha, WI
Is gastric residual volume (GRV) monitoring an effective predictor of risk and outcomes in critically ill, intubated patients receiving enteral tube feedings?
Measuring the GRV is not an effective predictor of risk and outcomes
in critically ill, intubated patients receiving enteral tube feedings based on evidence findings.
Clinical Bottom Line:
(Metheny et al., 2008, pp. 516-517)
Comments on the Evidence:
Strengths:Reignier et al (2013) multi-site study with large sample size, reflecting 80% Power coupled with RCT methodology supports generalizability of findings. Although Methany et al (2010) uses a descriptive design, attention to confounding variables strengthens generalizability.
Limitations: Overall, there is a lack of empirical evidence examining the value of monitoring GRVs in critical ill patients and general quality of extant literature is lacking. The integrative review was identified by researchers as a systematic review, despite lack of rigor in methodology. Only one study reported conduct of a power analysis. Reliability and validity of measurement methods was not addressed by researchers.
Applicability: Patients who did not have continual GRV monitoring were found to achieve a greater caloric intake than those who did receive continual GRV monitoring. The absence of GRV monitoring was not found to be inferior to GRV monitoring regarding Ventilator-Associated Pneumonia (VAP), ICU/hospital length of stay (LOS), organ failure scores, and mortality rates. Continually monitoring GRV in tube fed patients takes focus away from more important aspects of nursing care, increases hospital expenses, and disrupts necessary tube feedings for critically ill patients.
Evidence Search: PubMed, CINAHL, EBSCO
Key words: gastric residual volume, aspiration, tube feeding