Gastric Residual Volume Measurement in U.K. PICUs: A Survey of Practice

Lyvonne N. Tume; Barbara Arch; Kerry Woolfall; Lynne Latten; Elizabeth Deja; Louise Roper; Nazima Pathan; Helen Eccleson; Helen Hickey; Michaela Brown; Anne Beissel; Izabela Andrzejewska; Chris Gale; Frédéric V. Valla; Jon Dorling

doi:10.1097/PCC.0000000000001944

Gastric Residual Volume Measurement in U.K. PICUs: A Survey of Practice

Lyvonne N. Tume, Barbara Arch, Kerry Woolfall, Lynne Latten, Elizabeth Deja, Louise Roper, Nazima Pathan, Helen Eccleson, Helen Hickey, Michaela Brown, Anne Beissel, Izabela Andrzejewska, Chris Gale, Frédéric V. Valla, Jon Dorling

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15 Citas (Scopus)

Resumen

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.

Idioma original	English
Páginas (desde-hasta)	707-713
Número de páginas	7
Publicación	Pediatric Critical Care Medicine
Volumen	20
N.º	8
DOI	https://doi.org/10.1097/PCC.0000000000001944
Estado	Published - ago. 1 2019
Publicado de forma externa	Sí

Nota bibliográfica

Funding Information:
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal). Supported by the National Institute of Health Research (Health Technology Assessment reference 16/94/02). Drs. Tume’s, Arch’s, Latten’s, Deja’s, Roper’s, Eccleson’s, Hickey’s, Brown’s, and Gale’s institutions received funding from National Institute Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

Funding Information:
of Health Research (NIHR) Health Technology Assessment Programme. Drs. Tume, Arch, Latten, Roper, Pathan, Eccleson, Hickey, and Brown received support for article research from NIHR Health Technology Assessment Programme. Dr. Hickey’s institution received funding from NIHR Efficacy and Mechanism Evaluation Programme (EME Ref (15):/20/01), and she received funding from University of Liverpool (personal fees relating to the production of a Clinical Study Report for University Hospitals Bristol NHS Foundation Trust). Ms. Brown’s institution received funding from the NIHR Doctoral Fellowship Programme. Dr. Gale’s institution received funding from Medical Research Council, Chiesi Pharmaceuticals, Canadian Institute of Health Research (CIHR), and Department of Health (England); he has received support from Chiesi Pharmaceuticals to attend an educational conference; in the past 5 years, he has been an investigator on received research grants from Medical Research Council, NIHR, CIHR, Department of Health in England, Mason Medical Research Foundation, Westminster Medical School Research Trust, and Chiesi Pharmaceuticals; and he received support for article research from Research Councils UK. Dr. Valla received funding from Baxter, Fresenius Kabi, and Nutricia. Dr. Dorling’s institution received funding from National Institute for Health Research and Nutricia in 2017 and 2018 for part of his salary to work as an expert advisor on a trial of enteral insulin; he disclosed he was a member of the NIHR HTA General Board (from 2017 to 2018) and the NIHR HTA Maternity, Newborn and Child Health Panel (from 2013 to 2018); and he received support for article research from NIHR. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: lyvonne.tume@uwe.ac.uk

Publisher Copyright:
Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

ASJC Scopus Subject Areas

Pediatrics, Perinatology, and Child Health
Critical Care and Intensive Care Medicine

PubMed: MeSH publication types

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

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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.",

author = "Tume, {Lyvonne N.} and Barbara Arch and Kerry Woolfall and Lynne Latten and Elizabeth Deja and Louise Roper and Nazima Pathan and Helen Eccleson and Helen Hickey and Michaela Brown and Anne Beissel and Izabela Andrzejewska and Chris Gale and Valla, {Fr{\'e}d{\'e}ric V.} and Jon Dorling",

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doi = "10.1097/PCC.0000000000001944",

language = "English",

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T1 - Gastric Residual Volume Measurement in U.K. PICUs

T2 - A Survey of Practice

AU - Tume, Lyvonne N.

AU - Arch, Barbara

AU - Woolfall, Kerry

AU - Latten, Lynne

AU - Deja, Elizabeth

AU - Roper, Louise

AU - Pathan, Nazima

AU - Eccleson, Helen

AU - Hickey, Helen

AU - Brown, Michaela

AU - Beissel, Anne

AU - Andrzejewska, Izabela

AU - Gale, Chris

AU - Valla, Frédéric V.

AU - Dorling, Jon

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N2 - 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.

AB - 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.

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Gastric Residual Volume Measurement in U.K. PICUs: A Survey of Practice

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