Gastric residual volumes in critically ill paediatric patients: A comparison of feeding regimens

Horn, Desley; Chaboyer, Wendy; Schluter, Philip J.

doi:10.1016/s1036-7314(04)80011-0

Cited by 38 publications

(40 citation statements)

References 17 publications

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“…Gastric residual volume (GRV) is routinely measured in the intensive care environment despite lack of evidence to support it as a useful marker of EN intolerance 18,19 . There is no consensus on the threshold of GRV that defines EN intolerance, and the practice of isolated GRV measurements to guide EN advancement is questionable 20,21 . A majority of the episodes of EN interruption at our center were due to heterogeneous practice around fasting times for procedures, lack of a uniform definition and inconsistency in managing EN intolerance, varied EN advancement strategies, and failure to prioritize nutritional support during daily rounds 5 .…”

Section: Discussionmentioning

confidence: 99%

A Stepwise Enteral Nutrition Algorithm for Critically Ill Children Helps Achieve Nutrient Delivery Goals*

Hamilton¹,

McAleer²,

Ariagno³

et al. 2014

Pediatric Critical Care Medicine

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Objective To evaluate the impact of implementing an enteral nutrition (EN) algorithm on achieving optimal EN delivery in the Pediatric Intensive Care Unit (PICU). Design Prospective pre/post implementation audit of EN practices. Setting One 29-bed medical/surgical PICU in a free standing, university affiliated children’s hospital. Patients Consecutive patients admitted to the PICU over two 4-week periods pre and post implementation, with a stay of > 24 hours who received EN. Interventions Based on the results of our previous study, we developed and systematically implemented a stepwise, evidence and consensus-based algorithm for initiating, advancing and maintaining EN in critically ill children. Three months after implementation, we prospectively recorded clinical characteristics, nutrient delivery, EN interruptions, parenteral nutrition (PN) use, and ability to reach energy goal in eligible children over a 4-week period. Clinical and nutritional variables were compared between the pre and post-intervention cohorts. Time to achieving energy goal was analyzed using Kaplan Meier statistical analysis. Measurements and Main Results Eighty patients were eligible for this study and were compared to a cohort of 80 patients in the pre-implementation audit. There were no significant differences in median age, gender, need for mechanical ventilation, time to initiating EN, or use of post-pyloric feeding between the 2 cohorts. We recorded a significant decrease in the number of avoidable episodes of EN interruption (3 vs. 51, p0.0001) and the incidence and duration of PN dependence in patients with avoidable EN interruptions in the post-intervention cohort. Median time to reach energy goal decreased from 4 days to 1 (p<0.0001), with a higher proportion of patients reaching this goal (99% vs. 61%, p = 0.01). Conclusions The implementation of an EN algorithm significantly improved EN delivery and decreased reliance on PN in critically ill children. Energy intake goal was reached earlier in a higher proportion of patients.

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Section: Discussionmentioning

confidence: 99%

A Stepwise Enteral Nutrition Algorithm for Critically Ill Children Helps Achieve Nutrient Delivery Goals*

Hamilton¹,

McAleer²,

Ariagno³

et al. 2014

Pediatric Critical Care Medicine

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“…In a recent single‐center study of children eligible for EN initiation in the PICU, measured GRV did not correlate with delayed gastric emptying or with the ability to rapidly advance EN 55 . The threshold volume used to define increased GRV in the PICU is variable 73 , 77 . In the absence of pediatric trials, we cannot recommend discontinuing GRV measurement in the PICU, but the role of this practice is not clear and might impede EN advancement.…”

Section: Introductionmentioning

confidence: 95%

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition

Mehta

Skillman

Irving

et al. 2017

J Parenter Enteral Nutr

373

515

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This document represents the first collaboration between 2 organizations-the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine-to describe best practices in nutrition therapy in critically ill children. The target of these guidelines is intended to be the pediatric critically ill patient (>1 month and <18 years) expected to require a length of stay >2-3 days in a PICU admitting medical, surgical, and cardiac patients. In total, 2032 citations were scanned for relevance. The PubMed/MEDLINE search resulted in 960 citations for clinical trials and 925 citations for cohort studies. The EMBASE search for clinical trials culled 1661 citations. In total, the search for clinical trials yielded 1107 citations, whereas the cohort search yielded 925. After careful review, 16 randomized controlled trials and 37 cohort studies appeared to answer 1 of the 8 preidentified question groups for this guideline. We used the GRADE criteria (Grading of Recommendations, Assessment, Development, and Evaluation) to adjust the evidence grade based on assessment of the quality of study design and execution. These guidelines are not intended for neonates or adult patients. The guidelines reiterate the importance of nutrition assessment-particularly, the detection of malnourished patients who are most vulnerable and therefore may benefit from timely intervention. There is a need for renewed focus on accurate estimation of energy needs and attention to optimizing protein intake. Indirect calorimetry, where feasible, and cautious use of estimating equations and increased surveillance for unintended caloric underfeeding and overfeeding are recommended. Optimal protein intake and its correlation with clinical outcomes are areas of great interest. The optimal route and timing of nutrient delivery are areas of intense debate and investigations. Enteral nutrition remains the preferred route for nutrient delivery. Several strategies to optimize enteral nutrition during critical illness have emerged. The role of supplemental parenteral nutrition has been highlighted, and a delayed approach appears to be beneficial. Immunonutrition cannot be currently recommended. Overall, the pediatric critical care population is heterogeneous, and a nuanced approach to individualizing nutrition support with the aim of improving clinical outcomes is necessary.

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“…Gastric emptying delay (GED) was defined as the difficulty in maintaining gastric residual volume within safe limits (GRV below 5 ml/kg) (Horn et al 2004). Based on the available evidence, it was categorised as light GED (151 -250 ml / 6h), moderate GED (251 -350 ml / 6h) or severe GED (> 350 ml / 6h).…”

Section: Data Collectionmentioning

confidence: 99%

To return or to discard? Randomised trial on gastric residual volume management

Juvé‐Udina

Valls-Miró

Carreño-Granero

et al. 2009

Intensive and Critical Care Nursing

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SUMMARYBackground: The control of gastric residual volume (GRV) is a common nursing intervention in intensive care; however the literature shows a wide variation in clinical practice regarding the management of GRV, potentially affecting patients' clinical outcomes.The aim of this study is to determine the effect of returning or discarding GRV, on gastric emptying delays and feeding, electrolyte, and comfort outcomes in critically ill patients.Method: A randomised, prospective, clinical trial design was used to study 125 critically ill patients, assigned to the return or the discard group. Main outcome measure was delayed gastric emptying. Feeding outcomes were determined measuring intolerance indicators, feeding delays and feeding potential complications. Fluid and electrolyte measures included serum potassium, glycaemia control and fluid balance. Discomfort was identified by significant changes in vital signs.Results: Patients in both groups presented similar mean GRV with no significant differences found (p=0,111), but participants in the intervention arm showed a lower incidence and severity of delayed gastric emptying episodes (p=0,001).No significant differences were found for the rest of outcome measurements, except for hyperglycaemia. Conclusions:The results of this study support the recommendation to reintroduce gastric content aspirated to improve GRV management without increasing the risk for potential complications.

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Gastric residual volumes in critically ill paediatric patients: A comparison of feeding regimens

Cited by 38 publications

References 17 publications

A Stepwise Enteral Nutrition Algorithm for Critically Ill Children Helps Achieve Nutrient Delivery Goals*

A Stepwise Enteral Nutrition Algorithm for Critically Ill Children Helps Achieve Nutrient Delivery Goals*

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition

To return or to discard? Randomised trial on gastric residual volume management

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