AB137. SOH26AB_0012. Introduction of a critical care pathway for the management of raised gastric residual volumes: enhancing gastrointestinal motility and patient outcomes
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AB137. SOH26AB_0012. Introduction of a critical care pathway for the management of raised gastric residual volumes: enhancing gastrointestinal motility and patient outcomes

Cathriona Murphy1, Margaret O’Donoghue2, Catherine Bird3, Diane Lawlor3, Caitriona Cody1

1Department of Anaesthesiology and Critical Care Medicine, Connolly Hospital Blanchardstown, Dublin, Ireland; 2Department of Dietetics, Connolly Hospital Blanchardstown, Dublin, Ireland; 3Department of Pharmacy, Connolly Hospital Blanchardstown, Dublin, Ireland

Background: Adequate nutrition is vital in critical care, with malnutrition associated with increased morbidity and mortality. Enteral feeding intolerance due to raised gastric residual volumes (GRV) is common in critically ill patients, influenced by factors such as immobility, drug effects, and mechanical ventilation. Prior to this, no standardised approach for GRV management existed in the intensive care unit (ICU), leading to inconsistent practice. This study aimed to introduce a critical care pathway for the management of raised gastric volumes.

Methods: Following approval from the audit committee, a prospective 2-week audit was conducted in February 2025, including fourteen patients, with data collected on demographics, length of ICU stay, and GRV. A multidisciplinary pathway based on the 2023 European Society for Clinical Nutrition and Metabolism guidelines was then developed, approved by the Drugs and Therapeutics Committee, and introduced after staff education. A re-audit in March 2025 included ten patients.

Results: In the initial audit, the mean GRV threshold prompting intervention varied widely (150–400 mL). Prokinetic agents were administered in 14% (2/14) of patients, and in 21% (3/14) of cases where they were indicated, they were not given. Following pathway implementation, compliance improved, eliminating missed indications for prokinetic therapy and demonstrating enhanced recognition and standardised management of delayed gastric emptying.

Conclusions: The introduction of a structured, evidence-based pathway for GRV management has improved consistency and nutrition delivery in the ICU. Ongoing education and audit cycles will sustain compliance and enable measurement of outcomes such as feeding adequacy, aspiration rates, and length of stay. Future integration into the MEG eGuides app will enhance accessibility and embed this practice change into routine critical care.

Keywords: Critical care; gastric residual volumes (GRV); enteral nutrition; prokinetic pathway; clinical pathway

Acknowledgments

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Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-26-ab137
Cite this abstract as: Murphy C, O’Donoghue M, Bird C, Lawlor D, Cody C. AB137. SOH26AB_0012. Introduction of a critical care pathway for the management of raised gastric residual volumes: enhancing gastrointestinal motility and patient outcomes. Mesentery Peritoneum 2026;10:AB137.

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