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      Gastric Residual Volume measurement in UK paediatric intensive care units: a survey of practice

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          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.

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          Author and article information

          Contributors
          Journal
          100954653
          Pediatr Crit Care Med
          Pediatr Crit Care Med
          Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
          1529-7535
          8 March 2019
          August 2019
          01 August 2020
          : 20
          : 8
          : 707-713
          Affiliations
          Associate Professor in Child Health, University of the West of England, Faculty of Health & Applied Sciences, Blackberry Hill, Bristol, BS16 1DD UK, Phone: +44 7710 412 142
          Statistician, Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, University of Liverpool, Institute of Child Health, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP
          Senior Lecturer, MRC Hubs for Trials Methodology Research, Department of Health Services Research, University of Liverpool, Block B, Room B112, 1 st Floor Waterhouse Building, Liverpool L69 3GL
          Advanced Paediatric Dietician Critical Care, Alder Hey Children’s Hospital, Liverpool, L12 2AP
          Department of Health Services Research, Block B, 1st Floor, Waterhouse Building, University of Liverpool, Liverpool L69 3GX
          Chartered Health Psychologist, Department of Health Services Research, Block B, 1st Floor, Waterhouse Building, University of Liverpool, Liverpool L69 3GX
          Consultant and University Lecturer in Paediatric Intensive Care, University of Cambridge, Addenbrooke’s Hospital, Cambridge, CB2 0QQ
          Trial Coordinator, Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, University of Liverpool, Institute of Child Health, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP
          Head of Trial Management, Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, University of Liverpool, Institute of Child Health, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP
          Senior Statistician, Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, University of Liverpool, Institute of Child Health, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP
          Consultant in Neonatal Intensive Care Unit, Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 bd Pinel, 69500 Lyon-Bron, France
          Neonatal Unit Coordinator/Neonatal Research Nurse, Chelsea and Westminster Hospital, Neonatal Unit, 3rd Floor, lift bank D, 369 Fulham Road, London, SW10 9NH
          Clinical Senior Lecturer in Neonatal Medicine, Imperial College London, Chelsea and Westminster Hospital campus, London, Sw10 9NH
          Consultant in Pediatric Intensive Care Medicine, Pediatric Intensive Care Unit, CarMEN INSERM UMR 1060 Equipe INFOLIP, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 bd Pinel, 69500 Lyon-Bron, France and Visiting Research Fellow, University of the West of England, Faculty of Health & Applied Sciences, Blackberry Hill, Bristol, BS16 1DD, UK
          Professor of Pediatrics and Division Head, Dalhousie University and IWK Health Centre, Division of Neonatal-Perinatal Medicine, 5850/5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia, Canada, B3K 6R8
          Author notes
          Corresponding Author: Lyvonne N Tume, Lyvonne.tume@ 123456uwe.ac.uk
          Article
          PMC6692165 PMC6692165 6692165 ems82038
          10.1097/PCC.0000000000001944
          6692165
          31398180
          Categories
          Article

          neonates, enteral feeding, intensive care, nutrition, children

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