الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
E
arly enteral nutrition is the standard of care in critically ill patients receiving invasive mechanical ventilation. However, numerous studies have shown that early enteral nutrition is frequently not used. The main reason for nonuse is gastrointestinal intolerance to enteral nutrition which has been ascribed to gastroparesis with increased gastric volume, gastroesophageal reflux, and regurgitation or vomiting carrying a risk of aspiration and ventilator-associated pneumonia (McClave et al., 2009).
This theoretical sequence has prompted a recommendation to monitor the residual gastric volume of mechanically ventilated patients receiving early enteral nutrition. When the residual gastric volume exceeds a predetermined cutoff, gastric prokinetic drugs are given and enteral nutrition is decreased or stopped to minimize the risk of aspiration and subsequent ventilator-associated pneumonia. However, no studies have established that residual gastric volume monitoring decreases the ventilator-associated pneumonia risk, and the measurement technique has never been validated. Moreover, the role for gastric content aspiration in ventilator-associated pneumonia has been challenged (Deane et al., 2007).
This is a Prospective cohort study that was conducted at Ain Shams University Hospitals& Rashid General hospital for 6 months on critically ill patients admitted to ICU with mechanical ventilation.
Sample sizes of 215 in each group totaling 430 in the study achieve 80% power to detect a non-inferiority margin difference between the group proportions of -0.0800. The reference group proportion is 0.158. The treatment group proportion is assumed to be 0.078 under the null hypothesis of inferiority.
Age was distributed as 54.84±9.31 and 56.14±10.3 with no significant difference between groups. This is in agree with Faramarzi et al. (2020) where the mean age was 57.72±19.01 years.
Our study patients had SAPS II (Simplified Acute Physiology Score) and SOFA (Sequential Organ Failure Assessment) scores indicating severe acute illness. SAPS II, scores range from 0 (lowest level of critical illness) to 163 (most severe level of critical illness with 100% predicted mortality. A score of 50 predicts a 46.1% risk of death. SAPS II was calculated 24 hours after ICU admission and SOFA scores range from 0 (no organ failure) to 24 (most severe level of multiple-organ failure).
there was no significant difference between groups regard BMI (is calculated as weight in kilograms divided by height in meters squared), SAPS II or SOFA regard sex distribution the majority were male in both groups with no significant difference and also DM and HTN distributed with no significant difference between groups
Considering cause of admission and risk factors distribution between studied groups, in our study there is no significant difference or association between the two groups and the majority admission causes of both groups were respiratory and cancer.
No significant difference between groups regard hospital stay or ICU days but MV days were significantly shorter in intervention group.
In our study, Ventilator-Associated Pneumonia wasnot significantly associated with group over another as in control group 23.7% had pneumonia while 18.1% in intervention group had it.
In the present study, cumulative calories deficit was significantly lower in intervention group, Intolerance and Prokinetic TTT were significantly associated with control group
CONCLUSION
T
he current study supports the hypothesis that a protocol of enteral nutrition management without residual gastric volume monitoring is not inferior to a similar protocol including residual gastric volume monitoring in terms of protection against VAP. Residual gastric volume monitoring leads to unnecessary interruptions of enteral nutrition delivery with subsequent inadequate feeding and should be removed from the standard care of critically ill patients receiving invasive mechanical ventilation and early enteral nutrition.