Effect of not monitoring residual gastric volume on ventilator-associated pneumonia
Reignier 2013 trial design and results
Design
Multicentre randomised non-inferiority trial
Treatment
No monitoring of residual gastric volume
Control
Routine monitoring of residual gastric volume
Population
449 adults receiving mechanical ventilation and early enteral feeding
Follow-up
90 days
Primary endpoint
Ventilator-associated pneumonia
Result
Ventilator-associated pneumonia occurred in 38 of 227 (16.7%) in the no-monitoring group and 35 of 222 (15.8%) in the monitoring group — difference 0.9%, 90% CI -4.8% to 6.7%, meeting non-inferiority.
Among adults requiring mechanical ventilation and receiving early enteral nutrition, the absence of gastric volume monitoring was not inferior to routine residual gastric volume monitoring in terms of development of VAP.
The trial authors, in the published abstract
How it has aged
A de-implementation result that removes a nursing ritual performed millions of times a day worldwide. Not monitoring also improved calorie delivery, since residuals were the usual reason feeds were stopped.
Publications
Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial
Reignier J, Mercier E, Le Gouge A, et al. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA 2013 Jan 16;309(3):249-56.
Non-inferior rates of ventilator-associated pneumonia