A 55-year-old man with Fournier's gangrene undergoes debridement and is admitted to ICU. He is sedated and ventilated. Enteral nutrition via a nasogastric tube is prescribed. If gastric residual volumes (GRVs) remain above 500 mL repeatedly, what is the recommended action per ESPEN/ASPEN 2022 guidelines?

• A Stop enteral nutrition and switch to TPN immediately
• B Continue feeding and add a prokinetic agent; cease EN only if GRV > 500 mL with symptoms ✓
• C Discontinue EN and withhold nutrition for 48 hours
• D Reduce feed rate to 10 mL/hr regardless of GRV

Explanation

ESPEN 2019 and ASPEN 2022 guidelines state that a GRV of 200–500 mL should prompt prokinetic therapy (e.g., metoclopramide or erythromycin) and post-pyloric feeding consideration, but should not trigger cessation of EN alone. A GRV > 500 mL combined with clinical signs (vomiting, abdominal distension, increased aspiration risk) warrants temporary cessation and reassessment. EN should not be stopped solely based on GRV in the absence of clinical deterioration; early EN reduces ICU mortality and infectious complications.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.