Efficacy and Tolerability of Non-Routine Gastric Residual Volume Monitoring in Mechanically Ventilated Adults Receiving Early Enteral Nutrition: A Randomised Controlled Non-Inferiority Trial.

Single centre, unblinded trial in ICU patients receiving nasogastric feeding, so results may not apply to other settings or tube types. Feeding intolerance was defined only as vomiting or gastric residual volume above 200 mL; diarrhoea, abdominal distension and aspiration were not measured. The study did not evaluate common intolerance features such as diarrhoea, abdominal distension or aspiration. Baseline groups were described as similar, but the baseline table reports a significant difference in SOFA scores, and the authors adjusted for several factors. The non-inferiority conclusion is not firmly established because the primary result was not significant and the confidence interval allowed a possible increase in feeding intolerance. Varying feeding volumes, underlying high-wasting diseases and prokinetic drug use may have influenced outcomes. Subgroup analyses were limited by small sample size.

The authors declared no conflicts of interest. The study was supported by National High Level Hospital Clinical Research Funding and the Chinese Academy of Medical Sciences.

Do not read the non-significant result as proof that daily monitoring is equivalent to routine frequent monitoring. The main analysis did not show a significant difference, but the estimate still allowed a possible increase in feeding intolerance, and important intolerance signs such as aspiration, diarrhoea and abdominal distension were not measured.