A randomised controlled trial of no routine gastric residual monitoring to guide enteral feeding in paediatric intensive care units (GASTRIC-PICU)

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Background

A common practice in UK Paediatric Intensive Care Units (PICUs) is to frequently measure the gastric aspirate (also known as the gastric residual volume, or GRV) to make decisions about starting or stopping feeds. The process involves the aspiration (or withdrawal using a syringe) of the entire stomach contents. GRV is historical and embedded into practice with very little evidence to support it.

Children in intensive care are, on average, receiving less than half of the calories they need, which can impact on the time a child spends on a ventilator, wound healing and contracting healthcare-related infections. There are many reasons why children do not receive adequate nutrition in PICU but one of the main reasons is the frequent measurement of GRV, which can lead to the unnecessary stopping of feeds.

Design

We aim to conduct a large-scale, clinical trial to find out whether no routine GRV measurement is safe and beneficial when compared to current routine practice of measuring GRV (at least every 6 hours). We hope to include 4,700 children from 19 NHS PICUs in the study. GASTRIC-PICU is a randomised controlled trial. This means that each child can be randomly assigned to either receive the intervention, where they will have no routine GRV measurement, or to receive the usual care that they would outside of the study. 

We will find out whether no routine GRV measurement is as effective at achieving target energy requirements after 72 hours, and as effective at guiding enteral feeding at 30 days, compared to usual care of frequent GRV measurement for children in PICU. This evaluation will potentially have a large impact on clinical practice in the NHS.

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