If gastric residual volumes remain elevated, which intervention is recommended?

• A. Stop EN altogether
• B. Consider promotility agents
• C. Switch to PN
• D. Increase feeding rate

Answer: (B)

Elevated gastric residual volumes reflect delayed gastric emptying, which means feeds linger in the stomach and tolerance worsens. The best way to address this while continuing enteral nutrition is to use promotility (prokinetic) agents. These medications stimulate gastric motility, enhance antral contractions, and speed up emptying, which reduces residual volumes and improves tolerance to feeds. This approach helps maintain enteral nutrition rather than stopping it or switching to parenteral nutrition right away. Increasing the feeding rate would likely worsen the residuals, and while switching to PN can be considered if EN remains intolerable despite prokinetics, the first and most appropriate step is to promote motility.