Madeleine H. Lef�vre
Routine gastric residual volume measurement and energy target achievement in the PICU: A comparison study
Lef�vre, Madeleine H.; Tume, Lyvonne N; Bickerdike, Anna; Latten, Lynne; Davies, Simon; Nicolas, Ga�lle W.; Valla, Frederic
Authors
Lyvonne N Tume
Anna Bickerdike
Lynne Latten
Simon Davies
Ga�lle W. Nicolas
Frederic Valla
Abstract
Critically ill children frequently fail to achieve adequate energy intake and some care practices, such as the measurement of gastric residual volume (GRV) may contribute to this problem. We compared outcomes in two similar European Pediatric Intensive Care Units (PICUs): one which routinely measures GRV (PICU-GRV) to one unit that does not (PICU-noGRV). An observational pilot comparison study was undertaken. 87 children were included in the study, 42 (PICU-GRV) and 45 (PICU-noGRV). There were no significant differences in the percentage of energy targets achieved in the first four days of PICU admission although PICU-noGRV showed more consistent delivery of median (and IQR) energy targets, and less under and over feeding for PICU-GRV and PICU-noGRV Day 1 37 (14-72) vs 44 (0-100); Day 2 97 (53-126) vs 100 (100-100), Day 3 84 (45-112) vs 100 (100-100) , Day 4 101 (63-124) vs 100 (100-100). The incidence of vomiting was higher in PICU-GRV. No necrotising enterocolitis was confirmed in either unit and ventilator acquired pneumonia rates were not significantly different (7.01 vs 12 5.31 per 1000 ventilator days; p=0.70) between PICU-GRV and PICU-noGRV units. Conclusions: The practice of routine gastric residual measurement did not significantly impair energy targets in the first four days of PICU admission. However, not measuring GRV did not increase vomiting, ventilator acquired pneumonia or necrotising enterocolitis, which is the main reason clinicians cite for measuring GRV.
What is known?
• The practice of routinely measuring gastric residual volume is widespread in critical care units
• This practice is increasingly being questioned in critically ill patients, both as a practice that increases
• the likelihood of delivering inadequate enteral nutrition amounts and as a tool to assess feeding tolerance
What is new?
• Not routinely measuring gastric residual volume did not increase adverse events of ventilator acquired pneumonia, necrotising enterocolitis or vomiting
• In the first four days of PICU stay, energy target achievement was not significantly different, but the rates of under and over feeding were higher in the routine GRV measurement unit
Journal Article Type | Article |
---|---|
Acceptance Date | Sep 5, 2017 |
Online Publication Date | Sep 18, 2017 |
Publication Date | Dec 31, 2017 |
Deposit Date | Sep 5, 2017 |
Publicly Available Date | Oct 13, 2017 |
Journal | European Journal of Pediatrics |
Print ISSN | 0340-6199 |
Electronic ISSN | 1432-1076 |
Publisher | Springer (part of Springer Nature) |
Peer Reviewed | Peer Reviewed |
Volume | 176 |
Issue | 12 |
Pages | 1637-1644 |
DOI | https://doi.org/10.1007/s00431-017-3015-8 |
Keywords | enteral feeding, pediatric intensive care, nursing practice, nutrition, feeding tolerance, critically ill child |
Public URL | https://uwe-repository.worktribe.com/output/877027 |
Publisher URL | http://dx.doi.org/10.1007/s00431-017-3015-8 |
Contract Date | Oct 3, 2017 |
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