Early initiation of gastric tube feeding: ultrasound assessment. A prospective interventional study

Background Early enteral nutrition is crucial in managing critically ill patients. Ultrasound is a promising modality for evaluating gastric residual volume (GRV). Aim This research was designed to study the effects of early initiation of enteral tube feeding in critically ill patients. Patients and methods Fifty critically ill patients aged 18 years or older, indicated for early initiation of enteral tube feeding, underwent ultrasound GRV and clinical assessment to monitor feeding tolerability as the primary outcome. The impact on the nutritional status, clinical outcomes, and efficacy of gastric ultrasound for guiding the initiation and continuation of gastric tube feeding by tracing GRV were studied as secondary outcomes. Results After early enteral tube feeding initiation, gastric intolerance symptoms were observed as follows: nausea in seven (14%) patients, vomiting in seven (14%) patients, constipation in nine (18%) patients, abdominal distention in six (12%) patients, and diarrhea in six (12%) patients. On day 1, 94% of patients reached their daily feeding goals, with 96% consistently meeting them in the following days. The participants had a statistically significant increase in serum prealbumin levels from a mean of 18.75±4.61 to 20.85±5.76 mg/dl ( P <0.001). At the same time, mid-arm circumference decreased from a mean of 30.52±5.01 to 29.71±5.10 cm ( P =0.004). A mean ICU length of stay of 10±2 days and a 28-day mortality rate of 14% was recorded. A poor agreement was statistically found between the clinical picture of feed intolerance and GRV measured by ultrasound. Conclusion Early enteral tube feeding initiation in critically ill patients guided by GRV ultrasound assessment could be tolerated with a possible beneficial impact on the patient’s nutritional status and clinical outcomes. GRV assessment using ultrasound showed poor agreement with the clinical picture of feed intolerance.