RELATIONSHIP BETWEEN GASTRIC RESIDUAL VOLUME AND DOSAGE OF
NORADRENALIN ADMINISTERED IN CRITICAL PATIENTS: THERE IS
NEED TO SUSPENSION OF ENTERAL NUTRITION?

Name: André Ochotorena dos Santos
Type: MSc dissertation
Publication date: 14/02/2019
Advisor:

Name	Role
CLAUDIO PIRAS	Advisor *

Examining board:

Name	Role
CLAUDIO PIRAS	Advisor *
Crispim Cerutti Junior	Internal Examiner *
Luciano Cezar Pontes Azevedo	External Examiner *

Summary: Introduction: Patients taking norepinephrine usually suffer interruption
of enteral nutrition (NE). There are currently no studies demonstrating the
relationship between the increase in residual gastric volume (GRV) and
noradrenaline dose with the need for NE interruption. Objective: To determine if
there is a relationship between GRV and noradrenaline dose in hemodynamically
stable patients. Methodology: Work approved by the Research Ethics
Committee (CEP) of the Hospital Universitário Cassiano Antônio de Moraes
(HUCAM) under the number CAAE: 54515416.3.0000.5071. The patients were
hospitalized in the intensive care units of the State Emergency and Urgency
Hospital and Vila Velha Evangelical Hospital from May 2016 to August 2017.
These patients were divided into 4 groups, allocated per infusion dose of
noradrenaline: Group 1 - Less than 0.5 mcg/Kg/min; Group 2 - between 0.5 and
0.89 mcg/kg/min; Group 3 - between 0.9 and 1.3 mcg/kg/min; and Group 4 -
above 1.3 mcg/kg/min. The inclusion criteria were: have 18 years or older;
receiving a nasoenteric enteral nutrition with a closed system, by means of a
continuous infusion pump; receiving continuous infusion of noradrenaline; have
a mean arterial pressure greater than or equal to 65 mmHg and normal serum
lactate. Exclusion criteria: neurocritical patients and contraindication for the use
of food by the gastrointestinal tract. All participants signed the Informed Consent
Form (EHIC). The lactate was dosed daily. The GRV was aspirated with a 60 ml
syringe after one hour of closed tube with no diet infusion. Data were collected
daily in specific tables, and new data were collected whenever the noradrenaline
dose was changed. Results: A total of 60 patients were studied, 41 males (68.3%)
and 19 females (31.7%). We obtained 84 samples in 4 groups. In group 1, 49
samples were included, being 34 males (40.48%) and 15 females (17.86%). In
group 2, 20 samples were included, of which 13 were male (15.48%) and 7 were
female (8.33%). In group 3, there were five samples, one male (1.19%) and four
female (4.76%). In group 4, 10 samples were included, all of them male. The
oscillation of the dose of noradrenaline infused was from 0.09 mcg / kg / min to
3.49 mcg / kg / min. The residual gastric volume ranged from 1 ml to 1500 ml,
with a mean of 151.89 ml and a standard deviation of 265 ml. The ANOVA test
was used to verify the associations between the means of noradrenaline and
GRV dosages and noradrenaline and lactate dosages. In the analysis of
noradrenaline with GRV, no statistical difference was observed between groups
with p = 0.57. In the analysis of the infusion dose of noradrenaline with lactate, a
statistically significant difference was observed, with p <0.01. Conclusion: It was
concluded that there is no relationship between noradrenaline dose and residual
gastric volume in patients with stable hemodynamics.
Key words: Enteric Nutrition. Norephinefrine. Lactate. Severe disease