Ask an answerable question (PICO)：
The nutrition is important for critically patients in the intensive care unit and it has supportive and therapeutic functions. In order to prevent malnutrition, patients are often placed with nasogastric tubes for nutritional supplements. However, due to long-term bed rest and lack of activity, causes symptoms of intestinal feeding intolerance, such as abdominal distension and excess gastric remnant. Therefore, the immune response is reduced and wound healing is delayed, infection, metabolic disorder and organ dysfunction occur, and even delaying transfer out of the ICU, leading to increased mortality. Abdominal massage as a convenient, non-pharmacological improvement option. This paper was aimed to explore whether the application of abdominal massage can reduce abdominal distension and gastric residual volume for patients in intensive care unit. Pico-P: ICU patients with nasogastric tube; I: abdominal massage; C: no abdominal massage; O: abdominal fullness, gastric residual volume.
The Method and Analysis of Literature Review：
The literature searching database included: Cochrane library, Embase, PubMed, MEDLINE, CEPS, and CINAHL. Keywords include: P (ICU patients in intensive care unit with nasogastric tube), I (abdominal massage), O (abdominal fullness, gastric residual volume); Using OR, AND in Boolean Logic to conduct search, The search was focused on the systematic review and meta-analysis, and randomized control trials.
Critical Appraisal：
There were total of 40 articles found in Chinese and English literature databases. After a quick review of the topics and abstracts, 8 articles were deleted, 9 articles were excluded from non- ICU patients, 3 articles were excluded from infants and young children, 2 articles were excluded from head and neck cancer, 7 articles were excluded from interventional measures including traditional Chinese medicine essential oil treatment, and 3 articles were excluded from measurement results showing no abdominal distension. 5 RCTs articles have been included in the SR articles, and a total of 29 articles have been deleted. Total of 1 article appraised, with the appraising tool of CASP (2018) Systematic Literature Review Checklist. It is concluded abdominal massage can reduce gastric residual volume(MD= - 42.41, 95% CI：-71.43~-13.39；I² =91%)and improve abdominal distension (OR= 0.08, 95% CI：0.03~0.19；I² =26%), and the Oxford level of evidence are Level I.
Clinical Application of Evidence：
Referencing the literature, the team designed abdominal massage plan. The application was conducted from May 2, 2022 to May 18, 2022. We applied the abdominal massage to ICU patients with nasogastric tubes in a Northern Medical Center in Taiwan. They were randomly assigned to the knowledge translation group (N=15) and the control group (N=15). The patients in the knowledge translation group received abdominal massage twice a day, 15 minutes each time, for 5 consecutive days. The control group maintained the usual routine treatment, and finally compared before and after to monitor the degree of abdominal distension and gastric residual volume.
Evaluation of Effectiveness：
Total of 30 ICU patients were implemented and evaluated. There was significant difference in the number of abdominal distension relievers in the experimental group through statistical analysis. The gastric residual volume of the experimental group could be reduced from109.33cc to 26cc, a total reduction of 83.33cc gastric residual volume, which is significantly different from the control group (-83.33±22.89 vs. -27.33±15.34, p＜.001), abdominal massage could promote gastrointestinal motility. It is evident the abdominal massage can reduce the gastric residual volume from the clinical application.
Conclusions and Recommendations：
This article was aimed to explore whether abdominal massage cab reduces abdominal distension and gastric residual volume for ICU patients. Literature review is carried out through empirical methods, and the final intervention strategy is screened for clinical application. The results show the abdominal massage can significantly improve abdominal distension and reduce gastric residual volume for ICU patients with nasogastric tube in intensive care unit, which is consistent with the results mentioned in the systematic review literature. Abdominal massage is non-invasive, low-cost, and unlimited in location and time for application. These are the advantages of sustainable implementation. It is suggested to extend the application of abdominal massage to home care in order to increase patient comfort and satisfaction.
