Q What is the protocol for assessing gastric residual volumes? How often? Do we use the residual volume? What volume indicates that feedings should be withheld? Do we restart feedings at the same rate? What evidence supports the recommendations?

A Andrea D. Johnson, MPH, RD, LD, replies:

Monitoring gastric residual volumes (GRVs) to assess the safety of enteral tube feeding has been a routine practice in many intensive care units. This practice, however, has never been standardized. Protocols for monitoring have been incorporated into standards of care because high GRVs are thought to be due to delayed gastric emptying caused by intolerance to enteral formula that may result in aspiration of gastric contents. Most clinicians agree that large GRVs are dangerous and predispose patients to aspiration, but little agreement exists on the definition of large.

Elevated GRVs are not always a sign of...

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