Gastric residual volume

胃残留量
  • 文章类型: Systematic Review
    目的:对术前超声检查中观察到的糖尿病对胃体积影响的现有证据进行系统的文献综述。利用这篇系统文献综述的结果,本研究进行了一项荟萃分析,以调查糖尿病与出现高危胃部的风险增加(胃体积与肺吸入风险增加相关)之间是否存在关联.
    方法:回顾文章和荟萃分析。
    方法:综述已发表的文献。
    方法:共3366例患者接受手术治疗。
    方法:胃超声检查。
    方法:荟萃分析和文献综述的数据来自PubMed/Medline,Embase,WebofScience,以及从成立之日起至2023年1月的国家医学图书馆的Google学者数据库。所有纳入的研究都测量了糖尿病患者和无糖尿病患者的胃窦横截面积和/或胃残余体积。荟萃分析中使用的数据包括所有基于胃窦横截面积或胃残余体积的超声检查测量评估高危胃发生率的研究。
    结果:大多数整理的研究表明,糖尿病与胃窦横截面积和胃残余体积增加有关。对已发表报告的荟萃分析表明,糖尿病患者的高危胃发生率增加。
    结论:糖尿病与高风险胃的发生率增加有关。作者建议进行大型前瞻性试验,以确定当前禁食指南对接受手术的糖尿病患者的安全性。
    To conduct a systematic literature review of the current evidence on the effect of diabetes mellitus on gastric volume observed during a preoperative ultrasound examination. Using the results of this systematic literature review, a meta-analysis was performed to investigate whether there was an association between diabetes mellitus and an increased risk of presenting with a high-risk stomach (gastric volume associated with an increased risk of pulmonary aspiration).
    Review article and meta-analysis.
    Review of published literature.
    A total of 3366 patients underwent surgery.
    Gastric ultrasound examination.
    Data for the meta-analysis and literature review were collected from the PubMed/Medline, Embase, Web of Science, and Google Scholar databases of the National Library of Medicine from the date of inception to January 2023. All included studies measured the gastric antral cross-sectional area and/or gastric residual volume in patients with diabetes and those without diabetes. The data utilized in the meta-analysis included all studies that evaluated the incidence of high-risk stomachs based on ultrasonographic measurements of the gastric antral cross-sectional area or gastric residual volume.
    Most collated studies revealed that diabetes mellitus was associated with increased antral cross-sectional area and gastric residual volume. A meta-analysis of published reports indicated that patients with diabetes have an increased rate of high-risk stomachs.
    Diabetes mellitus is associated with an increased rate of high-risk stomachs. The authors recommend large prospective trials to ascertain the safety of the current fasting guidelines for patients with diabetes undergoing surgery.
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  • 文章类型: Systematic Review
    早产儿胃残留量可能受体位影响。进行了这项系统评价,以检查卧位对胃管喂养的早产儿胃残留量的影响。电子数据库(PubMed,MEDLINE,MEDLINE完成,学术搜索终极,CINAHL完成,科克伦,和Scopus)搜索了2011年至2022年之间发表的英文随机对照实验或准实验研究,研究了一个或多个卧位对早产儿胃残留量的影响。PICOS策略用于准备和报告系统评价。共检索到304篇,并对12篇文章的全文进行了适用性评估。删除排除的物品后,分析中包括10篇文章。证据的质量各不相同,有四项研究被认为质量差,而其余六项被认为质量从中等到良好。根据从研究中获得的结果,经确定,与其他两个位置相比,右侧和俯卧位的胃残留量最小,左侧和仰卧位的胃残留量更多,后两种立场之间没有区别。方法上的差异,例如对不同职位的评估,定位的时间和保持在同一位置的持续时间,胃残余量的测量次数使其难以得出确切的证据。我们得出结论,需要评估所有职位的高证据研究。
    Premature infants\' gastric residual volume may be affected by position. This systematic review was conducted to examine the effect of lying position on the gastric residual volume of preterm newborns fed by gastric tube. Electronic databases (PubMed, MEDLINE, MEDLINE Complete, Academic Search Ultimate, CINAHL Complete, Cochrane, and Scopus) were searched for randomized controlled experimental or quasiexperimental studies in English published between 2011 and 2022 investigating the effect of one or more lying positions on gastric residual volume in premature newborns. The PICOS strategy was used in preparing and reporting the systematic review. A total of 304 articles were retrieved, and the full texts of 12 articles were evaluated for suitability. After eliminating the excluded articles, 10 articles were included in the analysis. The quality of evidence varied, with four studies judged to have poor quality whereas the remaining six were considered to range from moderate to good in quality. Based on the results obtained from the studies, it was determined that gastric residual volume was the least in the right lateral and prone positions and more in the left lateral and supine positions compared with the other two positions, with no difference between the two latter positions. The methodological differences, such as the evaluation of different positions, the timing of positioning and the duration of maintaining in the same position, and the measurement times of gastric residual volume made it difficult to reach a definitive proof. We concluded that high-evidence studies evaluating all positions are needed.
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  • 文章类型: Meta-Analysis
    背景:在肠内营养护理中是否有必要监测胃残量存在诸多争议。我们旨在进行更新的荟萃分析,以评估监测或不监测胃残余量对患者预后和并发症的影响。
    方法:我们在2021年4月15日的CochraneLibrary数据库中搜索了关于胃残余体积和无胃残余体积监测影响的随机对照试验(RCT)。使用ReviewManager软件进行数据分析。
    结果:共纳入7项RCT,涉及1240例肠内营养患者。胃残余量监测与呕吐发生率降低相关(OR2.33,95%CI:1.68-3.24),而无胃液残留量监测与肠内营养不必要中断发生率降低相关(OR0.38,95%CI:0.26~0.55).腹胀发生率无显著差异(OR1.87,95%CI:0.82-4.28),腹泻(OR1.03,95%CI:0.74-1.43),VAP(OR0.83,95CI:0.37-1.89),机械通气持续时间(MD-0.06,95%CI:-1.22-1.10),ICU住院时间(MD-1.33,95%CI:-3.58-0.91)和死亡率(OR0.90,95%CI:0.61-1.34)。
    结论:不监测胃残留量与减少不必要的肠内营养中断有关,这些中断与喂养不足和呕吐风险增加有关。
    BACKGROUND: There are many controversies over the necessity of monitoring gastric residual volume in the nursing care of enteral nutrition. We aimed to conduct an updated meta-analysis to evaluate the effects of monitoring or not monitoring gastric residual volume on patients\' outcomes and complications.
    METHODS: We searched the Cochrane Library database to 15 April 2021 for randomized controlled trials (RCTs) on the effects of gastric residual volume and no gastric residual volume monitoring. Review Manager software was used for data analysis.
    RESULTS: A total of seven RCTs involving 1240 enteral nutrition patients were included. Gastric residual volume monitoring was associated with reduced incidence of vomiting (OR2.33, 95% CI:1.68-3.24), whereas no gastric residual volume monitoring was associated with reduced incidence of unnecessary interruptions of enteral nutrition (OR0.38,95% CI:0.26-0.55). There were no significant differences on the incidence of abdominal distention (OR1.87, 95% CI:0.82-4.28), diarrhoea (OR1.03,95% CI:0.74-1.43), VAP (OR0.83, 95%CI:0.37-1.89), duration of mechanical ventilation (MD -0.06,95% CI:-1.22-1.10), length of ICU stay (MD -1.33, 95% CI:-3.58-0.91) and mortality (OR0.90,95% CI:0.61-1.34).
    CONCLUSIONS: Not monitoring gastric residual volume is associated with reduced unnecessary interruptions of enteral nutrition related to inadequate feeding and increased risk of vomiting.
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  • 文章类型: Journal Article
    Despite current guidelines recommending fasting from solids for ≤6 hours and clear fluids for ≤2 hours prior to surgery, outdated practices endure; patients fast for unnecessarily prolonged periods because of beliefs regarding aspiration risk upon anaesthesia induction. This literature review aimed to identify and evaluate current interventions aiming to reduce preoperative fasting times for acutely ill hospital patients, summarizing effective interventional strategies and associated outcomes. EMBASE, MEDLINE, PreMEDLINE, and CINAHL were systematically searched. Quality of evidence was assessed using Cochrane risk-of-bias tools. Studies, of any type, reporting fasting times as a primary or secondary outcome were included. A total of 1918 potential studies were identified; of these, 16 studies were included. Seven studies investigated the effect of changing fasting protocol on gastric fluid volume/residual gastric volume (GFV/RGV) and gastric pH as surrogate measures for aspiration risk. No significant differences in GFV/RGV and gastric pH due to reduced preoperative fasting were reported, thus no change in aspiration risk. Eight studies documented improvements in patient-reported outcomes with shorter fasting times. However, this review identified a paucity of studies that trialled interventions to reduce fasting times as the primary aim. These interventions were multimodal and multidisciplinary in nature, incorporating principles of implementation science to successfully achieve significant reductions in fasting times. This review highlights that reducing the preoperative fasting period is safe while improving patient\'s physical and psychological well-being. Further high-quality studies that investigate multimodal interventions, and that utilize implementation science principles, are required in this area.
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  • 文章类型: Journal Article
    BACKGROUND: The assessment of residual gastric volume is common practice in critical care units. However, the effects and safety of discarding or returning gastric aspirates remain uncertain. Therefore, we aimed to evaluate the role of discarding or returning gastric aspirates on the gastric residual volumes in critically ill patients.
    METHODS: A comprehensive, systematic meta-analysis of randomized controlled trials (RCTs) on the efficacy and safety of discarding or returning gastric aspirates in critical ill patients was performed. Studies were identified by searching Pubmed and other databases (from inception to 31 Sept 2018). Summary odd ratios (ORs) or mean differences (MDs) with 95% confidence intervals were calculated using fixed- or random-effects model for outcome assessment.
    RESULTS: Four RCTs, with a total number of 314 adult patients, were included in the analysis. No significant differences were found in the 48th hour residual volume (MD = 8.89, 95% CI: 11.97 to 29.74), the average potassium level (MD = 0.00, 95% CI: - 0.16 to 0.16), the episodes of gastric emptying delay (OR = 0.98, 95% CI: 0.35 to 2.80), the incidence of aspiration pneumonia (OR = 0.93, 95% CI: 0.14 to 6.17), the episodes of nausea or vomiting (OR = 0.53, 95% CI: 0.07 to 4.13) and diarrhea (OR = 0.99, 95% CI: 0.58 to 1.70).
    CONCLUSIONS: No evidence confirms that returning residual gastric aspirates provides more benefits than discarding them without increasing potential complications. Rigorously designed, multi-center, large-sample randomized controlled trials must be further conducted to validate the role of discarding or returning residual gastric aspirates.
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  • 文章类型: Journal Article
    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.
    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.
    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.
    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.
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  • 文章类型: Journal Article
    OBJECTIVE: In critically ill patients, the optimal procedure to monitor upper gastrointestinal function is controversial. Several authors have proposed gastric residual volume (GRV) as a tool to guide enteral nutrition. The aim of this contribution is to briefly discuss corresponding studies.
    METHODS: We electronically searched MEDLINE, EMBASE, and CINAHL for studies relevant to the subject.
    RESULTS: Six randomized controlled trials (RCTs) and six prospective observational studies were identified. Each analyzed different thresholds of GRV to guide enteral nutrition and to avoid complications (e.g., vomiting, aspiration, nosocomial pneumonia) in artificially ventilated patients. Due to heterogeneity in outcome measures, patient populations, type and diameter of feeding tubes, and randomization procedures, combination of the results of the six RCTs into a meta-analysis was not appropriate. High-quality RCTs studying medical patients could not demonstrate an association between complication rate and the magnitude of GRV. The only observational study that adjusted results to potential confounders and that studied surgical patients found, however, that the frequency of aspiration increased significantly if a GRV > 200 mL was registered more than once.
    CONCLUSIONS: For mechanically ventilated patients with a medical diagnosis at admission to the intensive care unit, monitoring of GRV appears unnecessary to guide nutrition. Surgical patients might profit, however, from a low GRV threshold (200 mL).
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