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

Objectives: Despite little evidence, the practice of routine measurementof gastric residual volume to guide both the initiation anddelivery of enteral feeding in PICUs is widespread internationally.In light of increased scrutiny of the evidence surrounding thispractice, and as part of a trial feasibility study, we aimed to determineenteral feeding and gastric residual volume measurementpractices 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 invitedto collaboratively complete one survey per PICU and send a copy oftheir 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 routeas their primary feeding method. All but one PICU routinely measuredgastric residual volume, regardless of the method of feeding.Eighteen units had an agreed definition of feed tolerance, and allthese included gastric residual volume. Gastric residual volumethresholds for feed tolerance were either volume based (mL/kgbody weight) (11/21; 52%) or a percentage of the volume offeed administered (6/21; 29%). Yet only a third of units providedguidance about the technique of gastric residual volume measurement.Conclusions: Routine gastric residual volume measurement is partof standard practice in U.K. PICUs, with little guidance providedabout the technique which may impact the accuracy of gastricresidual volume. All PICUs that defined feed tolerance includedgastric residual volume in the definition. This is important to knowwhen proposing a standard practice arm of any future trial of no routine gastric residual volume measurement in critically ill children