Mentec et al. [7] showed that increased residual volumes were associated with decreased mean caloric intake in their patients. Nevertheless, other published trials [22, 23] report that using a higher GRV has benefits in terms of greater formula intake. This occurred also in our study. As a beneficial effect of using a 500-ml limit for GRV, instead of the more common limit of 200 ml, our patients received more enteral diet during the first 12 days of EN. Cumulative data for the 1st week of EN and at day 12 (the mean duration for EN in our series) indicate this fact. This is of interest because a negative energy balance has been correlated to the occurrence of complications in the ICU [12, 34]. According to the presented data, increasing the limit in GRV can be considered as a measure that could be implemented in order to decrease the energy deficit. Nevertheless, our data about differences in diet VR could be considered as ‘‘unimportant’’ for clinical implications; the accumulated difference in diet VR for the 1st week was only 3.7% (less than 100 kcal). This minimal difference in energy administration probably could explain the absence of effect on outcome variables in our patients. Recent data about the importance of tight caloric control on outcome variables suggest that a more important effect on caloric intake would be necessary to appreciate outcome effects, such as a decrease in mortality [35]. More investigation is needed to confirm the effect of increasing GRV in the efficacy of diet administration in critically ill patients receiving enteral nutrition.