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

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.