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Gastric Residual Volume Measurement in U.K. PICUs: A Survey of Practice*

Tume, Lyvonne N. RN, PhD1; Arch, Barbara MSc2; Woolfall, Kerry BA, MA, PhD3; Latten, Lynne Bsc (Hons), RD4; Deja, Elizabeth BSc, MSc, PhD5; Roper, Louise BSc, MSc, CPsychol5; Pathan, Nazima FRCPCH, PhD6; Eccleson, Helen Bsc (Hons)7; Hickey, Helen PgD (Dist)7; Brown, Michaela MSc7; Beissel, Anne MD8; Andrzejewska, Izabela RN, MSc9; Gale, Chris MRCPCH, PhD10; Valla, Frédéric V. MD, MSc11,12; Dorling, Jon MRCPCH, MD13

Pediatric Critical Care Medicine: August 2019 - Volume 20 - Issue 8 - p 707-713
doi: 10.1097/PCC.0000000000001944
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Objectives: Despite little evidence, the practice of routine measurement of gastric residual volume to guide both the initiation and delivery of enteral feeding in PICUs 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 measurement practices in U.K. PICUs.

Design: An online survey to 27 U.K. PICUs.

Setting: U.K. PICUs.

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 gastric residual volume.

Interventions: None.

Measurement and Main Results: Twenty-four of 27 units (89%) 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 gastric residual volume, regardless of the method of feeding. Eighteen units had an agreed definition of feed tolerance, and all these included gastric residual volume. Gastric residual volume 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 gastric residual volume measurement.

Conclusions: Routine gastric residual volume measurement is part of standard practice in U.K. PICUs, with little guidance provided about the technique which may impact the accuracy of gastric residual volume. All PICUs that defined feed tolerance included gastric residual volume in the definition. This is important to know when proposing a standard practice arm of any future trial of no-routine gastric residual volume measurement in critically ill children.

1Child Health, Faculty of Health & Applied Sciences, University of the West of England, Bristol, United Kingdom.

2Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, University of Liverpool Institute of Child Health Alder Hey Children’s NHS Foundation Trust Liverpool, Liverpool, United Kingdom.

3Department of Health Services Research, MRC Hubs for Trials Methodology Research, University of Liverpool, Liverpool, United Kingdom.

4Department of Dietetics, Alder Hey Children’s Hospital, Liverpool, United Kingdom.

5Department of Health Services Research, University of Liverpool, Liverpool, United Kingdom.

6Paediatric Intensive Care, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom.

7Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, University of Liverpool Institute of Child Health Alder Hey Children’s NHS Foundation Trust Liverpool, Liverpool, United Kingdom.

8Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon-Bron, France.

9Neonatal Unit/Neonatal, Chelsea and Westminster Hospital, London, United Kingdom.

10Neonatal Medicine, Imperial College London, Chelsea and Westminster Hospital campus, London, United Kingdom.

11Pediatric Intensive Care Unit, CarMEN INSERM UMR 1060 Equipe INFOLIP, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon-Bron, France.

12Faculty of Health & Applied Sciences, University of the West of England, Bristol, United Kingdom.

13Division of Pediatrics and Neonatal-Perinatal Medicine, Dalhousie University and IWK Health Centre, Halifax, NS, Canada.

*See also p. 774.

The views expressed are those of the author (s) and not necessarily those of the NHS, the National Institute of Health Research or the Department of Health and Social Care.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Supported by the National Institute of Health Research (Health Technology Assessment reference 16/94/02).

Drs. Tume’s, Arch’s, Latten’s, Deja’s, Roper’s, Eccleson’s, Hickey’s, Brown’s, and Gale’s institutions received funding from National Institute of Health Research (NIHR) Health Technology Assessment Programme. Drs. Tume, Arch, Latten, Roper, Pathan, Eccleson, Hickey, and Brown received support for article research from NIHR Health Technology Assessment Programme. Dr. Hickey’s institution received funding from NIHR Efficacy and Mechanism Evaluation Programme (EME Ref (15):/20/01), and she received funding from University of Liverpool (personal fees relating to the production of a Clinical Study Report for University Hospitals Bristol NHS Foundation Trust). Ms. Brown’s institution received funding from the NIHR Doctoral Fellowship Programme. Dr. Gale’s institution received funding from Medical Research Council, Chiesi Pharmaceuticals, Canadian Institute of Health Research (CIHR), and Department of Health (England); he has received support from Chiesi Pharmaceuticals to attend an educational conference; in the past 5 years, he has been an investigator on received research grants from Medical Research Council, NIHR, CIHR, Department of Health in England, Mason Medical Research Foundation, Westminster Medical School Research Trust, and Chiesi Pharmaceuticals; and he received support for article research from Research Councils UK. Dr. Valla received funding from Baxter, Fresenius Kabi, and Nutricia. Dr. Dorling’s institution received funding from National Institute for Health Research and Nutricia in 2017 and 2018 for part of his salary to work as an expert advisor on a trial of enteral insulin; he disclosed he was a member of the NIHR HTA General Board (from 2017 to 2018) and the NIHR HTA Maternity, Newborn and Child Health Panel (from 2013 to 2018); and he received support for article research from NIHR. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: lyvonne.tume@uwe.ac.uk

Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies