LN Tume , RN PhD, B Arch , MSc, K Woolfall , BA, MA, PhD, L Latten , Bsc (Hons) RD, E Deja , BSc, MSc, PhD, L Roper , BSc, MSc, CPsychol., N Pathan , FRCPCH PhD, H Eccleson , Bsc (Hons), H Hickey , PgD (Dist), M Brown , MSc, A Beissel , MD, I Andrzejewska , RN MSc, C Gale , MRCPCH PhD, FV Valla , MD MSc, J Dorling , MRCPCH MD
01 August 2020
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).
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.
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.
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.