Comparison of Caudal Block and Sacral Erector Spina Block for Postoperative Analgesia Following Pediatric Circumcision: A Double-Blind, Randomized Controlled Trial.

INTRODUCTION: Caudal block (CB) and erector spina plane block (ESPB) has been shown to provide effective postoperative analgesia following circumcision. Our aim was to compare the analgesic efficacy of sacral ESPB and CB, as well as the time to first analgesic requirement and postoperative complications. METHODS: Patients aged 1-7 years in the ASA I-II group, who were scheduled for circumcision were included in the study. Blocks were performed under general anesthesia before the operation. Postoperative pain was evaluated using the Face, Legs, Activity, Cry and Consolability (FLACC) scores. Analgesic requirements in the first 24 hours postsurgery, the time of first analgesia requirement, and postoperative complications were recorded. RESULTS: A total number of 150 patients were included in the study. In the CB group urinary retention was observed. No side effects were observed in the sacral ESPB group. The 4th and 6th hour postoperative FLACC scores were lower in the ESP group. The number of analgesic consumption in the first 24 hours postsurgery was significantly lower in the ESPB group (p <0.001). CONCLUSION: Based on our results, sacral ESPB performed with ultrasonography is a simple and safe regional anesthesia method that can be used to provide effective postoperative analgesia for circumcision.

The modified thoracoabdominal nerve block for post-operative analgesia in paediatric laparoscopic cholecystectomy.

The limited data on post-operative analgesia management after laparoscopic cholecystectomy in the paediatric population make it difficult for clinicians to manage pain in this group. Administration of a modified thoracoabdominal nerve block through a perichondrial approach (M-TAPA) has recently been identified as a technique providing effective analgesia on the anterior and lateral thoracoabdominal wall. Unlike thoracoabdominal nerve block through the perichondrial approach block, the local anaesthetic (LA) with M-TAPA block provides effective post-operative analgesia in abdominal surgery by affecting T5-T12 dermatomes, just like when applied to the lower part of the perichondrium. As far as we know, all patients in previous case reports were adults, and we did not come across any study on the effectiveness of M-TAPA in paediatric patients. We present our case who did not need any additional analgesic during the post-operative 24 h after an M-TAPA block was administered before paediatric laparoscopic cholecystectomy.

Obstructive sleep apnea in surgical patients and its relationship with difficult intubation: two years of experience from a single center.

BACKGROUND AND OBJECTIVES: In this study, we aimed to determine the risk of obstructive sleep apnea (OSA) in patients undergoing elective surgery and its relationship with difficult intubation (DI). METHODS: This prospective, descriptive, cross-sectional study was conducted between December 2018 and February 2020 in the anesthesiology and reanimation service of a training and research hospital. The study included patients who were ASA I...II, 18 years of age, and older who underwent elective surgery under general anesthesia. A form regarding the baseline characteristics of the participants as well as STOP-Bang score, Mallampati, and Cormack-Lehane classification was used to collect the data. RESULTS: The study included 307 patients. It was determined that 64.2% of patients had a high risk of OSA. The presence of DI (determined by repeated attempts at intubation) was 28.6% in the high-risk OSA group, while there was no DI in the low-risk OSA group. A statistically significant difference was found between the groups in terms of OSA risk according to the presence of DI according to repeated attempts, Cormack-Lehane classification, and Mallampati classification (p...<...0.001). CONCLUSION: Due to the high rate of DI in patients with a high risk of OSA, the security of the airway in these patients is endangered. Early clinical recognition of OSA can help in designing a safer care plan.

Effects of Long-term Administration of Inhaled Lavender During Hemodialysis on Patients' Invasive Pain, Anxiety, and Comfort During Cannulation: A Single-blind Randomized Controlled Trial.

Context: Although a number of studies have shown that lavender administered via inhalation can decrease the invasive pain and anxiety experienced by hemodialysis (HD) patients during cannulation, the evaluation has mostly been on the short-term effectiveness of lavender oil. Also, no study has evaluated the effects of lavender on comfort level. Objective: The study aimed to investigate the long-term effectiveness of lavender oil, when administered via an inhaler during HD sessions, on a patient's experience of invasive pain, anxiety, and comfort during access to the fistula. Design: The research team designed a prospective, single-blind, randomized, controlled clinical trial. Setting: The study took place in an HD unit of a public hospital in Kirklareli, Turkey. Participants: Participants were 24 patients receiving HD in the unit between January and March 2021. Intervention: Participants were randomly assigned to the intervention or control group. Pure lavender essence was diluted with sweet almond oil at a ratio of 1:10. Before the cannulation procedure at 12 HD sessions, three drops of a 1:10 mixture were placed on sterile gauze and held at a distance of about 10 cm from the participant's nose to ensure its inhalation before the fistula puncture with the needle. No extra procedure was performed for the control group. Outcome Measures: Participants completed a visual analogue scale (VAS) right after puncture of the fistula during each HD session. The STAI and HD Comfort Scale were scored at baseline prior to the first HD session and postintervention at the twelfth HD session. Results: The VAS (P < .001) and state anxiety scores (P = .027) were significantly lower in the intervention group than in the control group at all time points, except at baseline. The comfort scale in the intervention group was significantly higher than that in the control group (P < .05). Conclusions: Lavender aromatherapy could be a good option for reducing the pain, anxiety, and discomfort level of HD patients.

Ultrasound-Guided Pudendal Nerve Block versus Ultrasound-Guided Dorsal Penile Nerve Block for Pediatric Distal Hypospadias Surgery.

INTRODUCTION: The primary aim of the study was to use the duration until the first postoperative analgesic requirement after two different block techniques to compare the analgesic effect. The secondary aims were to compare the two methods for postoperative Children's Hospital Eastern Ontario Pain Scale (CHEOPS) scores, complications, and parental satisfaction level. MATERIALS AND METHODS: This prospective, observational study was conducted with male patients aged 1-7 years in the ASA I-II group, who were scheduled for hypospadias surgery between November 2019 and April 2020. Ultrasound (US)-guided pudendal nerve block (PNB) or US-guided dorsal penile nerve block (DPNB) was administered under general anesthesia before the operation. Postoperative analgesic need, postoperative pain, complications, and parental satisfaction were noted. The STROBE checklist was followed for reporting. RESULTS: The study was conducted with 30 patients in total, divided into 15 patients receiving PNB and 15 patients receiving DPNB. The effective minimum block duration was longer in the pudendal group at 22.22 ± 0.61 h than in the DPNB group at 22.19 ± 0.57 h. Additional analgesic was required in 4 subjects in the pudendal group and 5 in the DPNB group. There was no statistically significant difference in terms of the variables between the two groups (p > 0.05). DISCUSSION: US-guided DPNB and PNB were shown to provide successful postoperative analgesia and to have similar effectiveness in pediatric patients undergoing hypospadias surgery in this first prospective study of its kind in the literature. CONCLUSIONS: US-guided DPNB and PNB have been demonstrated to provide effective, safe, and long-term postoperative analgesia in pediatric patients who have undergone hypospadias surgery. Parental satisfaction in both groups is positively influenced by the minimum postoperative analgesia requirement, the long-term analgesic effect, and the lack of any complications.

Prevention of microbial colonization of feeding tubes in the intensive care unit.

BACKGROUND: Various microorganisms which increase the mortality rate in the intensive care unit (ICU) cause microbial colonization of the nasogastric tube (NGT) and use the NGT as a reservoir. AIM: To detect the colonization on the NGT and to determine the effect that training regarding hand hygiene, NGT management, and enteral feeding (EF) provided to ICU nurses and auxiliary service staff (ASS) has on the level of NGT colonization. STUDY DESIGN: A quasi-experimental pre-test and post-test control design was used in this study. Microbial samples were taken from the outer and inner parts of NGT. The microorganisms were categorized as: group 1, no risk; group 2, low risk pathogenic; group 3, high-risk pathogenic group. The training was given to nurses (n = 15) and ASS (n = 7). Hand hygiene, NGT, and EF care training are provided to nurses and ASS by researchers. A total of three training sessions were scheduled to be held in 3 weeks so that all health care staff members were trained. Each session lasted 2 h in total. Patients were assigned to a group if one of the microorganisms presented on the outer surface of the patient's feeding tube and/or on the hub. The hand hygiene compliance was evaluated by direct observation according to the World Health Organization hand hygiene indications. RESULTS: The study was conducted with 46 patients. Evaluating the patients for the presence of microorganisms before education revealed that 4.3% were in group 1, 21.8% were in group 2, and 73.9% were in group 3. After the education, evaluating the samples for the presence of microorganisms revealed that 39.1% were in group 1, 13% were in group 2, and 47.8% were in group 3. A statistically significant difference was found between the number of samples included in the groups after the participants had received training (H = 8.186; p = .017). CONCLUSIONS: An NGT could act as a reservoir of microbial colonization and high-risk microorganisms could be on the tube. Providing training not only to nurses but also to ASS will help reduce the risk of colonization. RELEVANCE TO CLINICAL PRACTICE: Eliminating such colonization with effective hand hygiene during NGT feeding is a cost-effective method. Providing training not only to nurses but also to ASS will help obtain the optimum benefit from patient care.

Obstructive sleep apnea in surgical patients and its relationship with difficult intubation: two years of experience from a single center

Abstract Background and objectives: In this study, we aimed to determine the risk of obstructive sleep apnea (OSA) in patients undergoing elective surgery and its relationship with difficult intubation (DI). Methods: This prospective, descriptive, cross-sectional study was conducted between December 2018 and February 2020 in the anesthesiology and reanimation service of a training and research hospital. The study included patients who were ASA I-II, 18 years of age, and older who underwent elective surgery under general anesthesia. A form regarding the baseline characteristics of the participants as well as STOP-Bang score, Mallampati, and Cormack-Lehane classification was used to collect the data. Results: The study included 307 patients. It was determined that 64.2% of patients had a high risk of OSA. The presence of DI (determined by repeated attempts at intubation) was 28.6% in the high-risk OSA group, while there was no DI in the low-risk OSA group. A statistically significant difference was found between the groups in terms of OSA risk according to the presence of DI according to repeated attempts, Cormack-Lehane classification, and Mallampati classification (p < 0.001). Conclusion: Due to the high rate of DI in patients with a high risk of OSA, the security of the airway in these patients is endangered. Early clinical recognition of OSA can help in designing a safer care plan.

Effect of the arterial needle bevel position on puncture pain and postremoval bleeding time in hemodialysis patients: A self-controlled, single-blind study.

AIM: This study aimed to investigate the effect of the bevel orientation (facing upwards or downwards towards the skin) of the needle inserted into the arterial limb of the arteriovenous fistula (AVF) on puncture pain and postremoval bleeding time. METHODS: This study, using a single-blind crossover design, was conducted on 35 maintenance hemodialysis patients who had been dialyzed for at least 6 months and in whom blood access was via an AVF. AVF cannulation was performed with the needle bevel pointing upward in the first six sessions and the needle bevel pointing downwards (towards the skin) in the subsequent six sessions. Needles were always inserted in the direction of blood flow. At each dialysis session, cannulation pain was measured using a visual analog scale (VAS), and the bleeding time at the end of dialysis after needle removal was recorded. FINDINGS: The VAS score and postremoval bleeding time were lower when the needle bevel pointed downwards towards the skin during insertion (P < 0.05). DISCUSSION: Insertion of the needle with the bevel pointed downward decreased puncture pain during cannulation and bleeding time postdialysis on needle removal.

Ultrasound-guided dorsal penile nerve block is a safe block in hypospadias surgery: A retrospective clinical study.

Caudal and dorsal penile nerve blocks are commonly used regional anesthesia methods in hypospadias surgery. Some studies have reported that regional anesthesia methods are risk factor for the development of postoperative complications following hypospadias surgery. The aim of the current study is to evaluate the relationship between postoperative complications and regional anesthesia methods used in distal hypospadias surgery. Forty-nine distal hypospadias patients were included. Patients had either received caudal or ultrasound (US)-guided dorsal penile nerve block. The age, type of hypospadias, regional anesthesia method, operation time, and postoperative complications were recorded. Fisher exact test and Mann-Whitney U tests were used to compare the data. Caudal epidural block was used in 25 (51%) patients and US-guided dorsal penile nerve block in 24 (49%) patients. There was no statistically significant difference between the groups regarding the types of hypospadias, operation time, and age. Fistula developed in 4 (16%) patients in the caudal block group and in none of the patients in the dorsal penile nerve block group. Fistula rates were statistically significantly different between the groups (P = .030). Conflicting data are found in the literature on the long-term postoperative complications of the regional anesthesia techniques used in hypospadias surgery. In our study, all patients with urethrocutaneous fistula were in the caudal block group. We believe that our study will contribute to the literature as it is the only study comparing caudal block with US-guided dorsal penile nerve block using in-plane technique in terms of postoperative complications in hypospadias surgery.

Ultrasound-guided thoracal paravertebral block for awake thoracoscopic lobectomy in a high-risk patient: The first reported case.

One-lung ventilation provided by double-lumen tube intubation under general anaesthesia has conventionally been considered necessary for thoracoscopic major pulmonary resections. Recently, regional anaesthesia techniques have been used to avoid complications of tracheal intubation and general anaesthesia. Although paravertebral block (PVB) comes to the fore as a safe and useful regional anaesthesia technique for intra-operative and post-operative analgesia for a wide variety of surgeries involving the thoracic and lumbar regions, it is sometimes used for anaesthesia. Here, we aimed to demonstrate that biportal video-assisted thoracoscopic surgery can be performed in a right upper lobectomy while maintaining spontaneous ventilation in a 55-year-old, awake patient who was not intubated under ultrasound-guided PVB.

Comparison of the postoperative analgesic effects of US-guided caudal block and US-guided pudendal nerve block in circumcision.

AIM: To compare the postoperative analgesic efficacy and postoperative complications of the pudendal nerve block (PNB) and caudal block (CB) with ultrasound (US). STUDY DESIGN: A prospective observational study. METHODS: This study was included male patients aged between 4 and 12 years in the ASA I-II group and scheduled for circumcision. A low-dose CB or US-guided PNB was administered under general anaesthesia before the operation. Postoperative pain was evaluated using the Children's Hospital Eastern Ontario Pain Scale (CHEOPS) and Faces Pain Scale-Revised. Postoperative analgesic need was also noted. RESULTS: The study was completed with a total of 100 patients consisting of 50 patients who received a CB and 50 who received a PNB. Intraoperative block failure was not seen in any patient. The mean CHEOPS score (P < .001) and the 6th (P = .003) and 12th hours (P < .001) CHEOPS scores were found to be statistically significantly higher in the CB group. There were no postoperative side effects in the PNB group with a statistically significant difference compared with the CB group (P = .027). CONCLUSION: This first prospective study in the literature shows that US-guided PNB provided a more pronounced and longer analgesic effect and resulted in less requirement for postoperative analgesics than US-guided CB.

A Comparison of the Postoperative Analgesic Effectiveness of Ultrasound-Guided Dorsal Penile Nerve Block and Ultrasound-Guided Pudendal Nerve Block in Circumcision.

AIM: The aim of this study was to compare the postoperative analgesic effectiveness of the 2 block types. We also aimed to evaluate the effect of these block types on the postoperative complications and parental satisfaction. MATERIALS AND METHODS: This prospective observational study was conducted between April and July 2019 at a training and research hospital. Patients aged between 5 and 12 years in the ASA I-II group, who were scheduled for circumcision, were included in the study. The primary outcome was the pain measured using the Children's Hospital Eastern Ontario Pain Scale and the Faces Pain Scale-Revised. The secondary outcomes were the postoperative complications and parenteral satisfactions. RESULTS: The number of patients receiving a pudendal block (n = 40) and dorsal penile nerve block (DPNB) block (n = 40) was equal. No statistically significant difference was found between the groups that were administered a DPNB and pudendal block in terms of pain scores (p > 0.05). We did not observe any postoperative block-related complications or side effects. Parents reported excellent satisfaction in both groups. DISCUSSION: Ultrasound (US)-guided pudendal nerve block and US-guided DPNB provided effective and long-lasting postoperative analgesia for circumcision surgery. CONCLUSIONS: This study has shown that both blocks provide postoperative analgesia with similar effectiveness and ensured a very comfortable period at the circumcision surgery. Clinicians can use either of these techniques depending on their clinical circumstances and experience.

Caudal epidural block versus ultrasound-guided dorsal penile nerve block for pediatric distal hypospadias surgery: A prospective, observational study.

BACKGROUND: The surgery of hypospadias is very painful in the postoperative period and requires long-term analgesia. A dorsal penile nerve block (DPNB) and caudal epidural block (CEB) are commonly used regional anesthesia techniques for postoperative pain control. OBJECTIVES: The primary aim of the prospective, observational study was to use the duration until the first postoperative analgesic requirement after two different block techniques to compare the analgesic effect. The secondary aims were to compare the two methods for postoperative Children's Hospital Eastern Ontario Pain Scale (CHEOPS) scores, complications and parental satisfaction level. STUDY DESIGN: This study was conducted with male patients aged 1-5 years in the ASA I-II group, who were scheduled for hypospadias surgery. A CEB or ultrasound (US)-guided DPNB with the in-plane technique was administered under general anesthesia before the operation. Postoperative analgesic need, postoperative pain, complications and parental satisfaction were noted. STROBE checklist was followed for reporting. RESULTS: The study was conducted with 26 patients in total, divided into 13 patients receiving CEB and 13 patients receiving DPNB. The mean CHEOPS score (p = 0.003) and 12th hour CHEOPS score (p = 0.003) were statistically significantly higher in the CEB group than the DPNB group. The need for additional postoperative analgesia was higher in the CEB group than the DPNB group (p < 0.001). No complications were seen in two groups. DISCUSSION: Dorsal penile nerve block with the US-guided in-plane technique provided effective and long-lasting postoperative analgesia for hypospadias surgery. CONCLUSION: The postoperative analgesia was better with DPNB than with CEB in hypospadias surgery, particularly in the first 12 h. Parental satisfaction was higher with DPNB thanks to the minimum postoperative analgesia requirement and lack of complications. CLINICALTRIALS. GOV IDENTIFIER: NCT04215874.

A comparison of the postoperative analgesic effectiveness of low dose caudal epidural block and US-guided dorsal penile nerve block with in-plane technique in circumcision.

BACKGROUND: Circumcision can be performed under sedo-analgesia, general anesthesia, or regional anesthesia. It may cause serious postoperative pain and patients often require additional analgesia. Dorsal penile nerve block (DPNB) and caudal epidural block are commonly used regional anesthesia methods to provide effective postoperative pain control in circumcision. OBJECTIVE: In this prospective observational study, we aimed to investigate the postoperative analgesic efficiency of DPNB with the ultrasound (US)-guided in-plane technique and single-dose caudal epidural block in circumcision. STUDY DESIGN: Male patients aged 4-12 years in the ASA I-II group, who were scheduled for circumcision, were included in the study. A caudal epidural block or US-guided DPNB with the in-plane technique was administered under general anesthesia before the operation. Postoperative pain was evaluated using the Children's Hospital Eastern Ontario Pain Scale (CHEOPS) and Faces Pain Scale-Revised (FPS-R). Postoperative analgesic need and parental satisfaction were also noted. RESULTS: There were 140 patients in our study. The number of patients receiving a caudal block (n = 70) and DPNB block (n = 70) was equal. Side effects were only seen in five patients in the caudal group. No side effects were seen in patients in the DPNB group. Analgesics were required in 3.6% of the patients in the caudal group and none of the patients in the DPNB group postoperatively. CHEOPS mean scores in the caudal block group were found to be statistically significantly higher than in the penile block group. FPS-R 24th. hour mean score was statistically significantly higher in the caudal block group (P < 0.001). Postoperative parental satisfaction in the penile block group was found to be statistically significantly better than in the caudal block group (P = 0.028). DISCUSSION: This study demonstrated that DPNB conducted with the US-guided in-plane technique was more effective than caudal block in providing postoperative analgesia. The parental satisfaction was also higher, and no side effect was seen in the DPNB group. CONCLUSION: DPNB conducted with the US-guided in-plane technique is a simple and safe regional anesthesia method used to provide effective postoperative analgesia for male circumcision. Complications related to DPNB can be prevented with the help of the real-time imaging provided by ultrasound.

Quantifying population-specific growth in benthic bacterial communities under low oxygen using H218O.

The benthos in estuarine environments often experiences periods of regularly occurring hypoxic and anoxic conditions, dramatically impacting biogeochemical cycles. How oxygen depletion affects the growth of specific uncultivated microbial populations within these diverse benthic communities, however, remains poorly understood. Here, we applied H218O quantitative stable isotope probing (qSIP) in order to quantify the growth of diverse, uncultured bacterial populations in response to low oxygen concentrations in estuarine sediments. Over the course of 7- and 28-day incubations with redox conditions spanning from hypoxia to euxinia (sulfidic), 18O labeling of bacterial populations exhibited different patterns consistent with micro-aerophilic, anaerobic, facultative anaerobic, and aerotolerant anaerobic growth. 18O-labeled populations displaying anaerobic growth had a significantly non-random phylogenetic distribution, exhibited by numerous clades currently lacking cultured representatives within the Planctomycetes, Actinobacteria, Latescibacteria, Verrucomicrobia, and Acidobacteria. Genes encoding the beta-subunit of the dissimilatory sulfate reductase (dsrB) became 18O labeled only during euxinic conditions. Sequencing of these 18O-labeled dsrB genes showed that Acidobacteria were the dominant group of growing sulfate-reducing bacteria, highlighting their importance for sulfur cycling in estuarine sediments. Our findings provide the first experimental constraints on the redox conditions underlying increased growth in several groups of "microbial dark matter", validating hypotheses put forth by earlier metagenomic studies.

Gastric residual volume measurement in the intensive care unit: an international survey reporting nursing practice.

BACKGROUND: Gastric residual volume measurement is routinely used to evaluate the feeding tolerance and gastro-oesophageal reflux in patients receiving enteral feeding therapy in the intensive care unit. However, little supportive evidence for this intervention is available as the usefulness of gastric residual volume measurements in patients receiving enteral feeding therapy in the intensive care is controversial. AIM: The aim of this study was to assess the practice of intensive care unit nurses related to gastric residual volume measurement in patients receiving enteral nutrition. METHODS: A survey was conducted among a sample of intensive care unit nurses (n = 832) from four hospitals in Turkey (n = 182) and attendees of the Annual Congress of the Flemish Society for Critical Care Nurses in Flanders, Belgium (n = 650). The survey instrument was developed by the researchers based on the related literature. RESULTS: A total of 480 nurses completed the questionnaire (response rate = 73%). Gastric residual volume is measured by 98·0% of respondents, with wide variations in the frequency of measuring. A 50-200 mL gastric residual volume is considered problematic by 45·5% (n = 183) of the participants, and only 18·4% (n = 81) reported their practice to be based on a current guideline. Strikingly, more experienced intensive care unit nurses appear to perform gastric residual volume measurements more commonly than their less experienced colleagues (p = 0·004), while the practice is more often reported to be performed in Belgium than in Turkey (p < 0·001). CONCLUSION: Gastric residual volume management could be improved by applying current evidence to daily nursing practice. RELEVANCE TO CLINICAL PRACTICE: Our results show that increased awareness of these guidelines by nurses is needed to reduce inefficient use of working time and resources, streamline clinical practices and improve patient outcomes. Current gastric residual volume measurement guidelines and up-to-date, relevant training should be provided to nurses.

Investigation of the knowledge and attitudes of patients who are undergoing hemodialysis treatment regarding their arteriovenous fistula.

PURPOSE: The major cause of morbidity in hemodialysis patients is arteriovenous fistula deficiency. The patient should have adequate knowledge to ensure arteriovenous fistula patency. Our aim is to investigate the knowledge and attitude of the patients undergoing hemodialysis treatment regarding arteriovenous fistula. METHODS: This study was conducted on 335 patients who met the study criteria. Data collection forms evaluating the "Socio-Demographic and Medical Characteristics" and "Knowledge and Attitudes about arteriovenous fistula" of the patients were developed following a literature review by the investigators. RESULTS: The rules most known and implemented were "to not measure blood pressure" and "to not draw blood from arms with fistula", while the least known and implemented were "to use blood vessels on the hands in arms without fistula for intravenous intervention" and "to know which situations cause hypotension". CONCLUSIONS: Hemodialysis patients with arteriovenous fistulas need to know that developing self-care behavior is a means to reconcile lifestyles with current health status. Accordingly, planned training in self-care should be provided to hemodialysis patients and their families, and nurses should repeat information to patients who demonstrate a lack of knowledge.

Evaluation of the effect on patient parameters of not monitoring gastric residual volume in intensive care patients on a mechanical ventilator receiving enteral feeding: A randomized clinical trial.

PURPOSE: This study aimed to evaluate the effects of not measuring gastric residual volume (GRV) in intensive care patients on a mechanical ventilator and receiving enteral feeding on the feeding intolerance, gastroesophageal reflux (GER) risk, and nutritional adequacy. METHODS: This randomized clinical study was performed in 2 medical intensive care units of 2 university hospitals in Ankara, Turkey. The patients were randomized into 2 groups. In the group with GRV monitoring, GRV was measured 3 times a day, and the GRV threshold was accepted as 250 mL. In addition, 24-hour pH monitoring was used in this group to assess the risk of GER. In the group without GRV monitoring, GRV was not measured. The patients were followed-up for 5 days. RESULTS: The feeding targets were reached more quickly in the group without GRV monitoring (n = 26) with no increase in the complication rate (P < .05). No significant relationship was found between GRV and GER in the group with GRV monitoring (n = 25) (P > .05). CONCLUSION: The discrepancies in GRV measurement make it unreliable for monitoring feeding intolerance and GER. The use of GRV measurements may therefore be discontinued as part of the standard care protocol in medical intensive care units.