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Gastric Residual Volume measurement in UK paediatric intensive care units: a survey of practice

Accepted version
Peer-reviewed

Type

Article

Change log

Authors

Abstract

Objective—Despite little evidence, the practice of routine measurement of gastric residual volume to guide both the initiation and delivery of enteral feeding in pediatric intensive care units is widespread internationally. In light of increased scrutiny of the evidence surrounding this practice, and as part of a trial feasibility study, we aimed to determine enteral feeding and Gastric Residual Volume (GRV) measurement practices in United Kingdom (UK) Pediatric Intensive Care Units (PICUs). Design—An online survey to 27 United Kingdom Pediatric Intensive Care Units Setting—United Kingdom Pediatric Intensive Care Units Subjects—A clinical nurse, senior doctor and dietician were invited to collaboratively complete one survey per PICU and send a copy of their unit guidelines on enteral feeding and GRV. Interventions—None Main Results—24/27 (89%) units approached completed the survey. Twenty-three units (95.8% 23/24) had written feeding guidelines and 19 units (19/23 83%) sent their guidelines for review. More units fed continuously (15/24 62%) than intermittently (9/24 37%) via the gastric route as their primary feeding method. All but one PICU routinely measured GRV, regardless of the method of feeding. Eighteen units had an agreed definition of feed tolerance, and all these included GRV. GRV thresholds for feed tolerance were either volume based (ml/kg body weight) (11/21 52%) or a percentage of the volume of feed administered (6/21 29%). Yet only a third of units provided guidance about the technique of GRV measurement. Conclusions—Routine GRV measurement is part of standard practice in UK PICUs, with little guidance provided about the technique which may impact the accuracy of GRV. All PICUs that defined feed tolerance included GRV in the definition. This is important to know when proposing a standard practice arm of any future trial of no routine GRV measurement in critically ill children.

Description

Keywords

children, enteral feeding, intensive care, neonates, nutrition

Journal Title

Pediatric Critical Care Medicine

Conference Name

Journal ISSN

1529-7535
1947-3893

Volume Title

20

Publisher

Lippincott Williams & Wilkins Ltd.
Sponsorship
National Institute for Health Research (NIHR) (via University of Bristol) ((CE-17-0423))