Gastric residual volume measurement in
U.K. PICUs: a survey of practice*

Tume, LN; Arch, B; Woolfall, K; Latten, L; Deja, B; Roper, L; Pathan, N; Eccleson, H; Hickey, H; Brown, M; Beissel, A; Andrzejewska, I; Gale, C; Valla, FV; Dorling, J

Abstract

Objectives: Despite little evidence, the practice of routine measurement
of gastric residual volume to guide both the initiation and
delivery of enteral feeding in PICUs 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 measurement
practices in U.K. PICUs.
Design: An online survey to 27 U.K. PICUs.
Setting: U.K. PICUs.
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 gastric residual volume.
Interventions: None.
Measurement and Main Results: Twenty-four of 27 units (89%)
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
gastric residual volume, regardless of the method of feeding.
Eighteen units had an agreed definition of feed tolerance, and all
these included gastric residual volume. Gastric residual volume
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 gastric residual volume measurement.
Conclusions: Routine gastric residual volume measurement is part
of standard practice in U.K. PICUs, with little guidance provided
about the technique which may impact the accuracy of gastric
residual volume. All PICUs that defined feed tolerance included
gastric residual volume in the definition. This is important to know
when proposing a standard practice arm of any future trial of no routine gastric residual volume measurement in critically ill children.

Citation

U.K. PICUs: a survey of practice*. Pediatric Critical Care Medicine, 20(8), 707-713. https://doi.org/10.1097/PCC.0000000000001944

• Journal Article Type: Article
• Publication Date: Aug 1, 2019
• Deposit Date: Sep 4, 2019
• Journal: Pediatric Critical Care Medicine
• Print ISSN: 1529-7535
• Publisher: Lippincott, Williams & Wilkins
• Volume: 20
• Issue: 8
• Pages: 707-713
• DOI: https://doi.org/10.1097/PCC.0000000000001944
• Publisher URL: http://dx.doi.org/10.1097/PCC.0000000000001944
• Related Public URLs: https://journals.lww.com/pccmjournal/pages/default.aspx
• Additional Information: Projects : GASTRIC Study