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Routine gastric residual volume measurement and energy target achievement in the PICU: A comparison study

Lefèvre, Madeleine H.; Tume, Lyvonne N; Bickerdike, Anna; Latten, Lynne; Davies, Simon; Nicolas, Gaëlle W.; Valla, Frederic

Authors

Madeleine H. Lefèvre

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

Anna Bickerdike

Lynne Latten

Simon Davies

Gaëlle 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

Citation

Lefèvre, M. H., Tume, L. N., Bickerdike, A., Latten, L., Davies, S., Nicolas, G. W., & Valla, F. (2017). Routine gastric residual volume measurement and energy target achievement in the PICU: A comparison study. European Journal of Pediatrics, 176(12), 1637-1644. https://doi.org/10.1007/s00431-017-3015-8

Journal Article Type Article
Acceptance Date Sep 5, 2017
Online Publication Date Sep 18, 2017
Publication Date Dec 31, 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

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