الفهرس 
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Abstract
Enteral nutrition plays a vital role in the management of critically ill patients, providing essential nutrients to support their recovery and minimize the risk of complications. However, feeding intolerance, characterized by delayed gastric emptying and the accumulation of gastric residual volume (GRV), is a common challenge in this population.
Understanding the impact of GRV and antral CSA on clinical outcomes is crucial for optimizing enteral nutrition strategies in the ICU. Identifying reliable predictors of feeding intolerance can aid in early intervention and the implementation of appropriate prokinetic therapies.
This study aimed to confirm validity of ultrasonographic gastric antral CSA measurements in the assessment of GRV, to assess whether gastric ultrasound would be useful to monitor the effect of prokinetic drugs in patients with increased GRV, and to detect the risk of aspiration in critically ill patients receiving enteral tube nutrition.
Summary of our results: The outcome was significantly different between the two study groups, as the gastric antrum cross sectional area (CSA) as measured by ultrasound had a median value of 818 mm2 (IQR, 720–1050). The median antral CSA in normal feeding group was 773 mm2 (IRQ, 685–856), and 1188 mm2 (933–1307). The enteral feeding volume was indifferent across patients with normal feeding and feeding intolerance. The frequency of aspiration pneumonia was similar across patients with patients with normal feeding and feeding intolerance (p=0.47).
No significant difference in GRV levels in patients who received only metoclopramide and those who additionally received trimebutine maleate (p>0.05). There was a positive correlation between gastric antrum CSA and aspirated GRV (Pearson’s correlation coefficient = 0.747, p<0.001). The receiver operating characteristics (ROC) analysis of the gastric antrum CSA for the diagnosis of GRV ≥250 ml showed an area under the curve (AUC) of 0.872 (95% CI, 0.821:0.924; p <0.001). Diagnostic performance of antral CSA at a cutoff value of 872 mm2 for the diagnosis of GRV ≥250 ml. The mortality rate within 28 days of ICU admission was 41%. No significant difference in the 28-days mortality rate between patients with normal feeding and feeding intolerance (p=0.73).
No significant differences regarding the number of days on mechanical ventilation/ or length of hospital stay between patients with normal feeding and feeding intolerance (p=0.79, 0.55, respectively).