Point of care gastric ultrasound confirms the inaccuracy of gastric residual volume measurement by aspiration in critically ill children: GastriPed study

Abstract

Introduction: No consensus exists on how to define enteral nutrition tolerance in
critically ill children, and the relevance of gastric residual volume (GRV) is currently
debated. The use of point-of-care ultrasound (POCUS) is increasing among pediatric
intensivists, and gastric POCUS may offer a new bedside tool to assess feeding tolerance
and pre-procedural status of the stomach content.
Materials and Methods: A prospective observational study was conducted in a tertiary
pediatric intensive care unit. Children on mechanical ventilation and enteral nutrition were
included. Gastric POCUS was performed to assess gastric contents (empty, full of liquids
or solids), and gastric volume was calculated as per the Spencer formula. Then, GRV
was aspirated and measured. The second set of gastric POCUS measurements was
performed, similarly to the first one performed prior to GRV measurement. The ability of
GRV measurement to empty the stomach was compared to POCUS findings. Both GRV
and POCUS gastric volumes were compared with any clinical signs of enteral feeding
intolerance (vomiting).
Results: Data from 64 children were analyzed. Gastric volumes were decreased
between the POCUS measurements performed pre- and post-GRV aspiration [full
stomach, n = 59 (92.2%) decreased to n = 46 (71.9%), p =0.001; gastric volume: 3.18
(2.40–4.60) ml/kg decreased to 2.65 (1.57–3.57), p < 0.001]. However, the stomach
was not empty after GRV aspiration in 46/64 (71.9%) of the children. There was no
association between signs of enteral feeding intolerance and the GRV obtained, nor with
gastric volume measured with POCUS.
Discussion: Gastric residual volume aspiration failed to empty the stomach and
appeared unreliable as a measure of gastric emptiness. Gastric POCUS needs further
evaluation to confirm its role.