Alder Hey Children's NHS FT and University of Central Lancashire, Eaton Rd, Liverpool L12 2AP, UK.
Alder Hey Children's NHS FT, Eaton Rd, Liverpool L12 2AP, UK.
Nurs Crit Care. 2017 Sep;22(5):293-297. doi: 10.1111/nicc.12304. Epub 2017 Jun 22.
Measuring gastric residual volume (GRV) to guide enteral feeding is a common nursing practice in intensive care units, yet little evidence supports this practice. In addition, this practice has been shown to potentially contribute to inadequate energy delivery in intensive care, which remains a problem in critically ill children.
We aimed to explore paediatric intensive care nurses' decision-making surrounding this practice.
This is a cross-sectional electronic survey in a single mixed general and cardiac surgical PICU in the UK.
The response rate was 59% (91/154), and responding nurses were experienced, with a mean PICU experience of 10·5 years (SD 8·09). The three main reasons for stopping or withholding enteral feeds were: the volume of GRV obtained (67%), the appearance of this gastric aspirate (40%) and the overall clinical condition of the child (23%). Most nurses reported checking GRV primarily to determine 'feed tolerance' (97%) as well as confirming feeding tube position (94%). Nurses' perceived harms from high GRV were: the risk of pulmonary aspiration (44%), malabsorption of feeds (20%) and the risk of vomiting (19%). GRV was measured frequently in this PICU, with 58% measuring GRV before every feed, 27% measuring every 4 h and 17% measuring every 6 h. The majority of nurses (84%) stated they would be worried or very worried if they could not measure GRV routinely.
PICU nurses' decision-making surrounding initiating and withholding enteral feeds and determining 'feed tolerance' remains heavily based on GRV. PICU nurses have significant fears around patient harm if they do not measure GRV routinely.
This nursing practice is likely to be one of the factors that impair the delivery of enteral nutrition in critically ill children, and as such, its validity and usefulness needs to be challenged and studied in future research.
测量胃残余量 (GRV) 以指导肠内喂养是重症监护病房的常见护理实践，但几乎没有证据支持这种做法。此外，这种做法已被证明可能导致重症监护中能量供应不足，这在危重病儿童中仍然是一个问题。
我们旨在探讨儿科重症监护护士在这一实践中的决策。
这是在英国一家综合和心脏外科儿科重症监护病房 (PICU) 进行的一项横断面电子调查。
回复率为 59%（91/154），参与调查的护士经验丰富，平均 PICU 经验为 10.5 年（SD 8.09）。停止或停止肠内喂养的三个主要原因是：获得的 GRV 量（67%）、胃抽吸物的外观（40%）和儿童的整体临床状况（23%）。大多数护士报告主要检查 GRV 以确定“喂养耐受性”（97%）以及确认喂养管位置（94%）。护士认为高 GRV 的危害包括：肺吸入风险（44%）、喂养物吸收不良（20%）和呕吐风险（19%）。在这个 PICU 中，GRV 经常被测量，58%的护士在每次喂养前测量 GRV，27%的护士每 4 小时测量一次，17%的护士每 6 小时测量一次。大多数护士（84%）表示，如果不能常规测量 GRV，他们会感到担心或非常担心。
PICU 护士在启动和停止肠内喂养以及确定“喂养耐受性”方面的决策仍然主要基于 GRV。如果不常规测量 GRV，PICU 护士对患者伤害的担忧很大。
这种护理实践可能是影响危重病儿童肠内营养供应的因素之一，因此，需要在未来的研究中对其有效性和有用性进行挑战和研究。
