Gastric Residual Volume Measurement in U.K. PICUs

Objectives: Despite little evidence, the practice of routine measurement\ud of gastric residual volume to guide both the initiation and\ud delivery of enteral feeding in PICUs is widespread internationally.\ud In light of increased scrutiny of the evidence surrounding this\ud practice, and as part of a trial feasibility study, we aimed to determine\ud enteral feeding and gastric residual volume measurement\ud practices in U.K. PICUs.\ud Design: An online survey to 27 U.K. PICUs.\ud Setting: U.K. PICUs.\ud Subjects: A clinical nurse, senior doctor, and dietician were invited\ud to collaboratively complete one survey per PICU and send a copy of\ud their unit guidelines on enteral feeding and gastric residual volume.\ud Interventions: None.\ud Measurement and Main Results: Twenty-four of 27 units (89%)\ud approached completed the survey. Twenty-three units (95.8%;23/24) had written feeding guidelines, and 19 units (19/23;\ud 83%) sent their guidelines for review. More units fed continuously\ud (15/24; 62%) than intermittently (9/24; 37%) via the gastric route\ud as their primary feeding method. All but one PICU routinely measured\ud gastric residual volume, regardless of the method of feeding.\ud Eighteen units had an agreed definition of feed tolerance, and all\ud these included gastric residual volume. Gastric residual volume\ud thresholds for feed tolerance were either volume based (mL/kg\ud body weight) (11/21; 52%) or a percentage of the volume of\ud feed administered (6/21; 29%). Yet only a third of units provided\ud guidance about the technique of gastric residual volume measurement.\ud Conclusions: Routine gastric residual volume measurement is part\ud of standard practice in U.K. PICUs, with little guidance provided\ud about the technique which may impact the accuracy of gastric\ud residual volume. All PICUs that defined feed tolerance included\ud gastric residual volume in the definition. This is important to know\ud when proposing a standard practice arm of any future trial of no routine gastric residual volume measurement in critically ill children.