Value of bedside ultrasound monitoring of gastric residual volume in guiding early enteral nutrition in BICU patients

doi:10.3877/cma.j.issn.1673-9450.2024.01.006

Abstract

Abstract:

Objective

To investigate the effect of bedside ultrasound monitoring gastric residual volume (GRV) on guiding early enteral nutrition (EN) in BICU patients.

Methods

Totally 66 BICU patients diagnosed and treated at Department of Burns and Plastic Surgery, Affiliated Huaihai Hospital of Xuzhou Medical University from January 2022 to June 2023 were enrolled into the prospective randomized contolled trial, including 36 severe burn patients and 30 extremely severe burn patients according to the severity of burn. According to the random number table method, the patients with severe burn were divided into observation group (with bedside ultrasound monitoring of GRV) and control group (with syringe extraction of gastric contents to estimate GRV), with 18 cases in each group. The patients with extremely severe burn were divided into observation group (with bedside ultrasound monitoring of GRV) and control group (with syringe extraction of gastric contents to estimate GRV), with 15 cases in each group. After 1, 3, 5, 7, 14, 21 and 28 days of treatment, total energy intake of enteral nutrition, incidence of feeding intolerance, hemoglobin (Hb), total protein (TP), albumin (ALB), globulin (GLB), prealbumin (PA), procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6), blood urea nitrogen (BUN), mechanical ventilation time, feeding compliance time, BICU hospitalization time and sepsis incidence were compared among 4 groups during treatment. Fisher exact probability test, Mann-Whitmey U test, independent sample t test and repeated analysis of measurement variance were used for data analysis.

Results

The incidence of feeding intolerance in the observation group was lower than that in the control group for both severe burn patients and extremely severe burn patients (P<0.05). In the treatment of 7 and 28 d, the Hb level of the observation group was higher than that of the control group in extemely severe burn patients (P<0.05). In the treatment of 1-7 days, the TP level of the observation group was higher than that of the control group in severe burn patients (P<0.05). In the treatment of 3-14 days, the ALB of the observation group was higher than that of the control group in both severe burn patients and extremely severe burn patients (P<0.05). In the treatment of 5-21 days, the PA level of the observation group was higher than that of the control group in severe burn patients (P<0.05). In the treatment of 5-28 days, the PA of the observation group was higher than that of the control group in extremely severe burn patients (P<0.05). In the treatment of 1-5 days and 14 d, the PCT of the observation group was lower than that of the control group in severe burn patients (P<0.05), while in the treatment of 3-14 days, the PCT of the observation group was lower than that of the control group in extremely severe burn patients (P<0.05). The IL-6 of the observation group was lower than that of the control group in 3 and 5 d of treatment in extremely severe burn patients (P<0.05). In extremely severe burn patients, the feeding compliance time of the observation group was shorter than those of the control group (P<0.05).

Conclusion

Bedside ultrasound monitoring of GRV in BICU patients can guide early EN therapy, which is beneficial to improving total enteral nutrition energy, reducing the incidence of feeding intolerance, improving nutritional metabolism, and reducing the body′s inflammatory response.

Key words: Bedside ultrasonic monitoring, Gastric residual volume, BICU patients, Early enteral nutrition

Peng Li, Qingwei Cui, Pan Zhang, Hao Tang, Mengmeng Zhuang, Han Sun, Yuan Sun, Dan Li, Wendi Chen, Xuefei Mao, Yong Sun. Value of bedside ultrasound monitoring of gastric residual volume in guiding early enteral nutrition in BICU patients[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2024, 19(01): 24-33.

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Figures/Tables 14

References 24

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组别	例数	性别(例)		年龄(岁，±s)	烧伤总面积[%，M(Q₁，Q₃)]	Ⅲ度烧伤面积[%，M(Q₁，Q₃)]	烧伤指数[%，±s]
组别	例数	男	女	年龄(岁，±s)	烧伤总面积[%，M(Q₁，Q₃)]	Ⅲ度烧伤面积[%，M(Q₁，Q₃)]	烧伤指数[%，±s]
观察组	18	13	5	50.78±9.91	38.00 (32.00，40.00)	14.00(12.25, 16.00)	25.94±2.46
对照组	17	12	5	49.05±11.04	38.00(34.00，41.00)	14.00(13.00，16.00)	26.11±2.41
χ²值/t值/Z值		0.010		0.485	－0.030	－0.150	－0.210
P值		0.630		0.631	0.970	0.880	0.835

组别	例数	性别(例)		年龄(岁，±s)	烧伤总面积[%，M(Q₁，Q₃)]	Ⅲ度烧伤面积[%，M(Q₁，Q₃)]	烧伤指数[%，±s]
组别	例数	男	女	年龄(岁，±s)	烧伤总面积[%，M(Q₁，Q₃)]	Ⅲ度烧伤面积[%，M(Q₁，Q₃)]	烧伤指数[%，±s]
观察组	18	13	5	50.78±9.91	38.00 (32.00，40.00)	14.00(12.25, 16.00)	25.94±2.46
对照组	17	12	5	49.05±11.04	38.00(34.00，41.00)	14.00(13.00，16.00)	26.11±2.41
χ²值/t值/Z值		0.010		0.485	－0.030	－0.150	－0.210
P值		0.630		0.631	0.970	0.880	0.835

组别	例数	性别(例)		年龄(岁，±s)	烧伤总面积[%，±s]	Ⅲ度烧伤面积[%，M(Q₁，Q₃)]	烧伤指数[%，±s]
组别	例数	男	女	年龄(岁，±s)	烧伤总面积[%，±s]	Ⅲ度烧伤面积[%，M(Q₁，Q₃)]	烧伤指数[%，±s]
观察组	13	10	3	43.00±16.40	62.69±16.60	28.00(23.00, 32.00)	46.19±10.71
对照组	14	10	4	50.21±16.32	59.35±15.77	29.00(23.00, 34.00)	45.57±11.05
Fisher值/t值/Z值		0.10		－1.14	0.53	－0.63	0.15
P值		0.74		0.26	0.59	0.52	0.88

组别	例数	性别(例)		年龄(岁，±s)	烧伤总面积[%，±s]	Ⅲ度烧伤面积[%，M(Q₁，Q₃)]	烧伤指数[%，±s]
组别	例数	男	女	年龄(岁，±s)	烧伤总面积[%，±s]	Ⅲ度烧伤面积[%，M(Q₁，Q₃)]	烧伤指数[%，±s]
观察组	13	10	3	43.00±16.40	62.69±16.60	28.00(23.00, 32.00)	46.19±10.71
对照组	14	10	4	50.21±16.32	59.35±15.77	29.00(23.00, 34.00)	45.57±11.05
Fisher值/t值/Z值		0.10		－1.14	0.53	－0.63	0.15
P值		0.74		0.26	0.59	0.52	0.88

组别	例数	1 d	3 d	5 d	7 d	14 d	21 d	28 d
观察组	18	361.67±7.07	474.44±44.35	922.22±73.21	951.11±74.90	1671.67±281.70	1983.33±73.88	2030.56±34.89
对照组	17	350.59±14.34	457.65±41.16	726.47±134.77	800.00±122.47	1588.24±182.63	1906.47±92.93	1987.65±33.45
t值		2.923	1.159	5.382	4.432	1.033	2.716	3.710
P值		0.006	0.255	<0.001	<0.001	0.309	0.010	0.001

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