Which of the following is NOT an evidence-based ASPEN/SCCM recommendation for minimizing aspiration risk?

• A. Head of bed elevated to 30-45 degrees
• B. Small bowel feeding compared with gastric feeding
• C. Use of prokinetic agents or narcotic antagonists
• D. Frequent checking of GRVs

Answer: (D)

Minimizing aspiration risk relies on strategies that reduce the amount of gastric contents available to reflux and reach the airway, while preserving safe and effective nutrition. Elevating the head of the bed to about 30–45 degrees helps prevent regurgitation by using gravity to keep contents away from the airway. If using enteral feeds, delivering them into the small bowel (post-pyloric) places the nutrition beyond the stomach, which lowers the likelihood that refluxed material will be aspirated. Prokinetic agents can improve gastric emptying and reduce residual volumes, helping to lower aspiration risk when gastric feeds are used. In contrast, routinely and frequently checking gastric residual volumes has not shown benefit in reducing aspiration or improving outcomes and can unnecessarily interrupt feeds, making it not an evidence-based practice for aspiration prevention.