Gastric residual volume in the ICU: can we do without measuring it?

Delivery of nutrition is one of the most commonly performed interventions in critically ill patients, and daily review of nutrition issues is now considered one of the important a??housekeepinga?? tasks on intensive care unit (ICU) ward rounds.1 Several high-quality sets of evidence-based clinical practice guidelines have been published in recent years, with all consistently recommending that enteral nutrition (EN) should be commenced through a nasogastric tube within the first 24 or 48 hours in most patients. In conclusion, although measurement of GRV in our ICUs may hold back our patients from receiving sufficient nutrition, this study does not prove beyond doubt that nonmeasurement of GRV is risk free. Given that we should a??first do no harm,a?? we should now await confirmatory studies before removing the GRV assessment from our ICUs. In the meantime, clinicians should take guidance from published evidence-based guidelines. Groups from the United States, Canada, and Australasia have all recommended a GRV threshold (in the range of 200-500 mL) above which interventions such as either holding or reducing the rate of EN should occur.2-4 Such recommendations are based on a reasonable but cautious approach to the current evidence. Nevertheless, we should congratulate these investigators for raising and then beginning to answer an important research question in the ICU. If one day the GRV a??mytha?? is finally debunked, we will be grateful to Dr Fanny and colleagues for being courageous enough to stop measuring the GRV in their patients and to systematically observe their results, an important step in the advancement of clinical practice.