Routine gastric residual volume measurement to guide enteral feeding in mechanically ventilated infants and children : the GASTRIC feasibility study

Tume, LN; Woolfall, K; Arch, B; Roper, L; Deja, E; Jones, AP; Latten, L; Pathan, N; Eccleson, H; Hickey, H; Parslow, R; Preston, J; Beissel, A; Andrzejewska, I; Gale, C; Valla, FV; Dorling, J

Abstract

Background
The routine measurement of gastric residual volume to guide the initiation and delivery of enteral feeding, is widespread in paediatric intensive care and neonatal units, but has little underlying evidence to support it.
Objective(s)
To answer the question: Is it feasible to conduct a trial of not measuring gastric residual volume on clinical outcomes in mechanically ventilated infants and children in the UK?
Design
A mixed methods study involving five linked work packages in two parallel arms, neonatal units and paediatric intensive care units. 1. A survey of units to establish current UK practice. 2. qualitative interviews with healthcare professionals and caregivers of children admitted to either setting. 3. A modified two-round e-Delphi survey to investigate health care professionals’ opinions on trial design issues and to obtain consensus on outcomes. 4. National databases were examined to determine the potential eligible populations. 5. Two consensus meetings, of health care professionals and parents to review the data and agreed consensus on outcomes that had not reached consensus in the e-Delphi.
Participants and setting
Parents of children with experience of ventilation and tube feeding in both neonatal units and in paediatric intensive care units, and health care professionals working in neonatal units and paediatric intensive care units.

Results
Baseline surveys showed the practice of gastric residual volume measurement was very common: 96% PICUs and 65% in neonatal units. Ninety percent of parents both from neonatal units and paediatric intensive care units supported a future trial, whilst highlighting concerns around possible delays in detecting complications. Health care professionals also indicated a trial was feasible, with 84% of staff willing to participate in a trial. Concerns expressed by junior nurses about the intervention arm of not measuring gastric residual volumes were addressed by developing a simple flowchart and education package. The trial design survey and e-Delphi study gained consensus on trial 12 PICU and 9 neonatal unit outcome measures and identified acceptable inclusion and exclusion criteria. Given the differences in physiology, disease processes, environments, staffing and outcomes of interest, two different trials are required in the two settings. Database analyses subsequently showed trials were feasible in both settings in terms of patient numbers. Of 16222 children who met the inclusion criteria in PICU 12 629 stayed > 3 days. In neonatal units, 15 375 neonates <32 weeks age. Finally, the two consensus meetings demonstrated ‘buy in’ from the wider UK neonatal communities and paediatric intensive care units and enabled us to discuss and vote on the outcomes that did not achieve consensus in the e-Delphi study.
Conclusions and future work
Two separate UK trials (one in neonatal units and one in paediatric intensive care units) are feasible to conduct, but they cannot be combined due to differences in outcome measures and treatment protocols, reflecting the distinctness of the two specialties.

Citation

Tume, L., Woolfall, K., Arch, B., Roper, L., Deja, E., Jones, A., …Dorling, J. (2020). Routine gastric residual volume measurement to guide enteral feeding in mechanically ventilated infants and children : the GASTRIC feasibility study. Health Technology Assessment, 24(23), https://doi.org/10.3310/hta24230

• Journal Article Type: Article
• Acceptance Date: Jan 29, 2020
• Publication Date: May 27, 2020
• Deposit Date: Jan 29, 2020
• Publicly Available Date: May 29, 2020
• Journal: Health Technology Assessment
• Print ISSN: 1366-5278
• Electronic ISSN: 2046-4924
• Publisher: NIHR Journals Library
• Volume: 24
• Issue: 23
• DOI: https://doi.org/10.3310/hta24230
• Publisher URL: https://doi.org/10.3310/hta24230
• Related Public URLs: https://www.journalslibrary.nihr.ac.uk/HTA/#/
• Additional Information: Additional Information : Originally titled "A feasibility study of no routine gastric residual volume measurement in mechanically ventilated infants and children : the GASTRIC study"; Corporate Creators : National Institute for Health Research; Access Information : © Queen’s Printer and Controller of HMSO 2020. This work was produced by Tume et al under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to NETSCC. Permission to reproduce material from the published report is covered by the UK government’s non-commercial licence for public sector information. (http://www.nationalarchives.gov.uk/doc/non-commercial-government-licence/version/2/); Projects : A Feasibility Study of no routine Gastric residual volume measurement in mechanically ventilated Infants and Children: the GASTRIC study