title: Gastric residual volumes in critically ill paediatric patients: a comparison of feeding regimens.
abstract: This study examined the effect of gastric feeding regimens, either continuous or intermittent, on fourth hourly gastric residual volumes (GRV) in a group of critically ill paediatric patients where delayed gastric emptying is defined as a GRV greater than 5ml/kg. A randomised controlled trial was conducted in a tertiary paediatric intensive care unit (PICU), with 45 participants being randomly assigned to either the continuous (n=22) or intermittent (n=23) gastric feeding groups. Participants remained in the assigned group for the duration of the study and, fourth hourly, GRV were assessed to monitor the incidence of delayed gastric emptying. Both groups were similar in age, weight, gender, diagnosis, paediatric index mortality (PIM) score, and usage of pharmacological agents known to affect the gastrointestinal tract. No differences emerged in study duration or the volume of administered enteral formula (ml/kg/day). The intermittent feeding group commenced enteral feeding earlier in the PICU admission (13.0 hours versus 18.5 hrs, p=0.05). Repeated measures analysis revealed no overall difference in median GRV/kg values between treatment groups over the 72 hour study period. Additionally, the incidence of fourth hourly GRV, greater than 5ml/kg, was not different between the continuous and intermittent feeding groups. The provision of enteral nutrition via the gastric route is a common treatment in the PICU, and GRV are frequently used as a measure of gastric tolerance. The result of this analysis provides some support for the theoretical definition of delayed gastric emptying being >5ml/kg. However, further work is required to confirm this finding and to determine its relevance when providing enteral nutrition to the critically ill paediatric patient.
authors.affiliation: Royal Children's Hospital, Brisbane, QLD.
authors.forename: Desley
authors.initials: D
authors.lastname: Horn
authors.forename: Wendy
authors.initials: W
authors.lastname: Chaboyer
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Schluter
mesh_terms: D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D005766:Gastrointestinal Contents; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D010043:Outcome and Process Assessment, Health Care; D010372:Pediatrics / Q000379:methods*; D011446:Prospective Studies
chemical_list: D005765:Gastrointestinal Agents; D009020:Morphine