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Perhaps the most vexing reason tube feedings are stopped centers around gastric residual volume (GRV) measurements.
Trials have shown that GRV measurements of 500 mL should be tolerated so that the patient's nutritional needs are met, without fear of increased aspiration events.27 Most clinicians picture the pylorus as a patent drain that allows unfettered egress of tube feeding from the stomach into the duodenum, but this is in direct opposition to gastric physiology, which mandates that receptive relaxation of the stomach must occur before gastric emptying ensues.
Although feeding intolerance can result from gastroparesis and ileus, which are common entities in ICU patients, clinicians should have a higher tolerance for GRV without undue fear of aspiration.
Patients with ongoing elevated GRV and feeding intolerance require a thoughtful evaluation because new-onset feeding intoler- ance is often a harbinger of impending sepsis or infectious com- plications. fte medical record and bedside nurse should be queried to determine when the patient last had a bowel move- ment, and a digital rectal examination should be performed looking for fecal impaction. fte feeding tube should be checked for patency and proper location on radiographs, which may also yield data on the presence of ileus, pseudo-obstruction, or suspected pneumonia, all of which are associated with feeding intolerance.
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