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Gastric residual volume measurement in UK paediatric intensive care units: A survey of practice

Tume, Lyvonne; Arch, Barbara; Woolfall, Kerry; Latten, Lynne; Deja, Elizabeth; Roper, Louise; Pathan, Nazima; Eccleson, Helen; Hickey, Helen; Brown, Michaela; Beissel, Anne; Andrzejewska, Izabela; Gale, Chris; Valla, Fr�d�ric; Dorling, Jon

Authors

Lyvonne Tume Lyvonne.Tume@uwe.ac.uk
Associate Professor in Child Health

Barbara Arch

Kerry Woolfall

Lynne Latten

Elizabeth Deja

Louise Roper

Nazima Pathan

Helen Eccleson

Helen Hickey

Michaela Brown

Anne Beissel

Izabela Andrzejewska

Chris Gale

Fr�d�ric Valla

Jon Dorling



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.

Citation

Tume, L., Arch, B., Woolfall, K., Latten, L., Deja, E., Roper, L., …Dorling, J. (2019). Gastric residual volume measurement in UK paediatric intensive care units: A survey of practice. Pediatric Critical Care Medicine, 20(8), 707-713. https://doi.org/10.1097/PCC.0000000000001944

Journal Article Type Article
Acceptance Date Feb 14, 2019
Online Publication Date Apr 1, 2019
Publication Date Aug 1, 2019
Deposit Date Feb 15, 2019
Publicly Available Date Apr 2, 2020
Journal Pediatric Critical Care Medicine
Print ISSN 1529-7535
Publisher Lippincott, Williams & Wilkins
Peer Reviewed Not Peer Reviewed
Volume 20
Issue 8
Pages 707-713
DOI https://doi.org/10.1097/PCC.0000000000001944
Keywords enteral feeding, child, intensive care, paediatric, neonatal
Public URL https://uwe-repository.worktribe.com/output/849418
Publisher URL http://dx.doi.org/10.1097/PCC.0000000000001944
Additional Information Additional Information : This is the accepted version of the article. The final published version is available online here: http://dx.doi.org/10.1097/PCC.0000000000001944

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