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VOLUME 19 , ISSUE 2 ( 2015 ) > List of Articles

RESEARCH ARTICLE

Gradual sucrose gastric loading test: A method for the prediction of nonsuccess gastric enteral feeding in critically ill surgical patients

Suun Sathornviriyapong, Yaowalak Polbhakdee

Keywords : Critical illness, enteral nutrition, predictions, stomach contents, sucrose

Citation Information : Sathornviriyapong S, Polbhakdee Y. Gradual sucrose gastric loading test: A method for the prediction of nonsuccess gastric enteral feeding in critically ill surgical patients. Indian J Crit Care Med 2015; 19 (2):92-98.

DOI: 10.4103/0972-5229.151017

License: CC BY-ND 3.0

Published Online: 01-02-2015

Copyright Statement:  Copyright © 2015; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background and Aims: Intolerance of gastric enteral feeding (GEN) commonly occurs in surgical Intensive Care Unit (SICU). A liquid containing sugar could prolong gastric emptying time. This study was to propose a method for prediction of nonsuccess GEN using gastric volume after loading (GVAL) following gradual sucrose gastric loading. Materials and Methods: Mechanical ventilator supported and hemodynamically stable patients in SICU were enrolled. About 180-240 min before the GEN starting, a sucrose solution (12.5%; 450 mosmole/kg, 800 mL) was administered via gastric feeding tube over 30 min with 45° head upright position. GVAL was measured at 30, 60, 90, and 120 min after loading. GEN success status using clinical criteria was assessed at 72 h after the starting GEN protocol. The receiving operating characteristic (ROC) and c statistic were used for discrimination at each time point of GVAL. Results: A total of 32 patients were enrolled and completed the protocol. 14 patients (43.7%) were nonsuccessful GEN. The nonsuccess group was found to have significantly more GVAL than the other group at all-time points during the test (P < 0.05). The most discriminating point of GVAL for the prediction of nonsuccess was 150 mL at 120 min after loading with a sensitivity of 92.3%, specificity of 88.9%, positive predictive value of 85.7%, negative predictive value of 94.1%, and ROC area 0.97 (95% confidence interval 0.91-1.00). Conclusion: A high GVAL following sucrose gastric loading test might be a method to predict nonsuccess GEN in critically ill surgical patients.


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  1. Chittawatanarat K, Pruenglampoo S, Kongsawasdi S, Chuatrakoon B, Trakulhoon V, Ungpinitpong W, et al. The variations of body mass index and body fat in adult Thai people across the age spectrum measured by bioelectrical impedance analysis. Clin Interv Aging 2011;6:285-94.
  2. Villet S, Chiolero RL, Bollmann MD, Revelly JP, Cayeux RN, Delarue J, et al. Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr 2005;24:502-9.
  3. Caddell KA, Martindale R, McClave SA, Miller K. Can the intestinal dysmotility of critical illness be differentiated from postoperative ileus? Curr Gastroenterol Rep 2011;13:358-67.
  4. Moreira TV, McQuiggan M. Methods for the assessment of gastric emptying in critically ill, enterally fed adults. Nutr Clin Pract 2009;24:261-73.
  5. Hurt RT, McClave SA. Gastric residual volumes in critical illness: What do they really mean? Crit Care Clin 2010;26:481-90, viii-ix.
  6. Hsu CW, Sun SF, Lee DL, Lin SL, Wong KF, Huang HH, et al. Impact of disease severity on gastric residual volume in critical patients. World J Gastroenterol 2011;17:2007-12.
  7. Little TJ, Gopinath A, Patel E, McGlone A, Lassman DJ, D′Amato M, et al. Gastric emptying of hexose sugars: Role of osmolality, molecular structure and the CCK1 receptor. Neurogastroenterol Motil 2010;22:1183-90, e314.
  8. Soop M, Nygren J, Myrenfors P, Thorell A, Ljungqvist O. Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance. Am J Physiol Endocrinol Metab 2001;280:E576-83.
  9. Jaffin BW, Kaye MD. The prognosis of gastric outlet obstruction. Ann Surg 1985;201:176-9.
  10. Goldstein H, Boyle JD. The saline load test - a bedside evaluation of gastric retention. Gastroenterology 1965;49:375-80.
  11. Singer P, Berger MM, Van den Berghe G, Biolo G, Calder P, Forbes A, et al. ESPEN guidelines on parenteral nutrition: Intensive care. Clin Nutr 2009;28:387-400.
  12. Reignier J, Mercier E, Le Gouge A, Boulain T, Desachy A, Bellec F, 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;309:249-56.
  13. Kreymann KG, Berger MM, Deutz NE, Hiesmayr M, Jolliet P, Kazandjiev G, et al. ESPEN guidelines on enteral nutrition: Intensive care. Clin Nutr 2006;25:210-23.
  14. Martin CM, Doig GS, Heyland DK, Morrison T, Sibbald WJ, Southwestern Ontario Critical Care Research Network. Multicentre, cluster-randomized clinical trial of algorithms for critical-care enteral and parenteral therapy (ACCEPT). CMAJ 2004;170:197-204.
  15. Heyland DK, Cahill NE, Dhaliwal R, Wang M, Day AG, Alenzi A, et al. Enhanced protein-energy provision via the enteral route in critically ill patients: A single center feasibility trial of the PEP uP protocol. Crit Care 2010;14:R78.
  16. Chittawatanarat K, Pokawinpudisnun P, Polbhakdee Y. Mixed fibers diet in surgical ICU septic patients. Asia Pac J Clin Nutr 2010;19:458-64.
  17. Moore FA, Moore EE, Jones TN, McCroskey BL, Peterson VM. TEN versus TPN following major abdominal trauma - reduced septic morbidity. J Trauma 1989;29:916-22.
  18. Yagci G, Can MF, Ozturk E, Dag B, Ozgurtas T, Cosar A, et al. Effects of preoperative carbohydrate loading on glucose metabolism and gastric contents in patients undergoing moderate surgery: A randomized, controlled trial. Nutrition 2008;24:212-6.
  19. Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg 2009;144:961-9.
  20. Berne JD, Norwood SH, McAuley CE, Vallina VL, Villareal D, Weston J, et al. Erythromycin reduces delayed gastric emptying in critically ill trauma patients: A randomized, controlled trial. J Trauma 2002;53:422-5.
  21. McClave SA, Snider HL. Clinical use of gastric residual volumes as a monitor for patients on enteral tube feeding. JPEN J Parenter Enteral Nutr 2002;26 6 Suppl: S43-8.
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