Vomiting refers to visible regurgitation of gastric content. Vomiting can be a sign of disease, gastrointestinal dysfunction such as ileus or gastroparesis or can be associated with medication use.
Feasibility/Equipment: Vomiting is a clinical sign, no specific equipment or training is necessary.
Scoring information: Present or absent. Repeated and massive vomiting may intuitively have an effect on outcome but has not been assessed in critical illness [1]. Massive vomiting should probably trigger imaging performed by US and placement of nasogastric tube in case of gastric overdistension.
Cost: None
Evidence: Vomiting may be associated with pneumonia in prospective studies [2].
Accuracy / measurement properties: Correlation with pneumonia: In a prospective study with 360 participants, vomiting was a risk factor for aspiration (p = 0.01, 4 vs. 16 patients) [2]. Correlation with other GI variables: A recent meta-analysis has shown that measurements of GRV may predict vomiting (RR 1.47, 95% CI 1.13 to 1.93, very low certainty evidence) [3]. Return of gastric residual volumes does not appear to increase the incidence of vomiting (RR 1.00, 95% CI 0.06 to 15.63; very low-certainty evidence) [3]. Vomiting is a symptom of a possible list defining acute gastrointestinal dysfunction grade 1 (out of 4) whereas as a single symptom in a patient with oral intake was not considered as a GI dysfunction in the GIDS score [4]. Within that dataset, it was not associated with 28-day or 90-day mortality (p = 0.677 and p = 0.941 respectively) [4].
References
1. Heyland DK, Ortiz A, Stoppe C, Patel JJ, Yeh DD, Dukes G, Chen YJ, Almansa C, Day AG: Incidence, Risk Factors, and Clinical Consequence of Enteral Feeding Intolerance in the Mechanically Ventilated Critically Ill: An Analysis of a Multicenter, Multiyear Database. Crit Care Med 2021, 49(1):49-59.
2. Metheny NA, Clouse RE, Chang YH, Stewart BJ, Oliver DA, Kollef MH: Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: frequency, outcomes, and risk factors. Crit Care Med 2006, 34(4):1007-1015.
3. Yasuda H, Kondo N, Yamamoto R, Asami S, Abe T, Tsujimoto H, Tsujimoto Y, Kataoka Y: Monitoring of gastric residual volume during enteral nutrition. Cochrane Database Syst Rev 2021, 9(9):CD013335.
4. Reintam Blaser A, Padar M, Mandul M, Elke G, Engel C, Fischer K, Giabicani M, Gold T, Hess B, Hiesmayr M et al: Development of the Gastrointestinal Dysfunction Score (GIDS) for critically ill patients – A prospective multicenter observational study (iSOFA study). Clin Nutr 2021, 40(8):4932-4940.