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Background A community hospital updated its nutrition support practices in 2016 through the elimination of monitoring gastric residual volume (GRV) in accordance with the 2016 Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. Methods This retrospective analysis (N = 61) compared incidence of feeding intolerance in 2 cohorts of adult critically ill patients pre-implementation (n = 36) and post-implementation (n = 25) of these guidelines into a nutrition support team's standard of practice policy. Differences in kilocalories and protein (gm) received and percent of daily prescribed kilocalories and protein received were also compared between the 2 cohorts. Results Mean episodes of gastrointestinal intolerance over the number of eligible days of receiving enteral nutrition in the critical care unit did not differ between the pre-implementation and post-implementation groups (P = 0.46). Compared with the pre-implementation group, the post-guideline implementation cohort was significantly more likely to meet higher percentages of both prescribed protein (71.8 ± 22.2% vs 55.9 ± 24.0%; P = 0.01) and energy requirements (93.4 ± 36.9% vs 69.6 ± 35.3%; P = 0.01), even after adjusting for potential confounders (age, body mass index, sex, and primary comorbid medical condition). Conclusion Elimination of routine monitoring of GRV may result in a greater percentage of prescribed daily nutrient requirements met by patients in the critical care setting, without adverse effects on feeding intolerance.

Despite the research supporting adequate enteral nutrition (EN) in intensive care unit (ICU) patients, underfeeding is still common. This quality improvement (QI) project was done to determine the effect of "volume-based" feeding on adequacy of EN delivery and provision of calories and protein in a surgical/trauma ICU (STICU).Mechanically ventilated STICU patients (n = 111) fed at least 72 hours after achieving their target goal of EN during their first week of admission were reviewed retrospectively in a QI project. Data were obtained before (n = 54) and after (n = 56) initiation of a "volume-based" feeding protocol (FEED ME - Feed Early Enteral Diet adequately for Maximum Effect).The proportion of EN volume and calories delivered increased significantly (rate based, 63% ± 20%; FEED ME, 89% ± 9%; P.0001), as did grams of protein/kg actual body weight (1.13 ± .29 to 1.26 ± .37; P = .036) using the FEED ME protocol. Groups were similar in patient demographics, clinical characteristics, and nutrition practices. Only slightly more diarrhea (rate based, 0; FEED ME, 6; P = .046) in gastric-fed patients was noted. The incidence of gastric residual volume350 mL (rate-based, 20 episodes; FEED ME, 11 episodes; P = .34) and emesis (5 vs 2 episodes; P = .22) was similar.A change in standard of practice to an EN volume-based feeding approach in a STICU led to a significant improvement in adequacy of calories and protein delivered, with only a slight increase in diarrhea.