Monitoring
Measuring gastric residual volume in excess of a threshold value has been used to monitor the risk for aspiration in patients who are tube-fed. Because the cut-off values for gastric residual volumes that clearly indicate aspiration risks vary among studies, these assessments have to be combined with clinical evaluation of feeding intolerance, which includes auscultation of bowel sounds and evaluation of abdominal distension.[41] One study suggested measures to reduce aspirations should be initiated when a gastric residual volume is >200 mL.[86] However, one Cochrane review of eight randomised controlled trials in intensive care units concluded that uncertainty remains about the effect of gastric residual volume monitoring on mortality, pneumonia, vomiting, and length of hospital stay.[87]
Because of the inert character of barium, long-term reactions and late toxicities are not usually expected, and complete radiological clearance is the norm. There are no extensive data on long-term complications from massive barium aspiration, but case reports suggest that abnormalities can be seen on high-resolution computed tomography scan up to 1 year later.[85] Therefore, it is reasonable to obtain follow-up chest imaging during the year after barium aspiration.
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