英国 PICUs 中胃残余量的测量：实践调查。
Gastric Residual Volume Measurement in U.K. PICUs: A Survey of Practice.
机构信息
Child Health, Faculty of Health & Applied Sciences, University of the West of England, Bristol, United Kingdom.
Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, University of Liverpool Institute of Child Health Alder Hey Children's NHS Foundation Trust Liverpool, Liverpool, United Kingdom.
出版信息
Pediatr Crit Care Med. 2019 Aug;20(8):707-713. doi: 10.1097/PCC.0000000000001944.
OBJECTIVES
Despite little evidence, the practice of routine measurement of gastric residual volume to guide both the initiation and delivery of enteral feeding in PICUs is widespread internationally. In light of increased scrutiny of the evidence surrounding this practice, and as part of a trial feasibility study, we aimed to determine enteral feeding and gastric residual volume measurement practices 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 invited to collaboratively complete one survey per PICU and send a copy of their 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 route as their primary feeding method. All but one PICU routinely measured gastric residual volume, regardless of the method of feeding. Eighteen units had an agreed definition of feed tolerance, and all these included gastric residual volume. Gastric residual volume thresholds for feed tolerance were either volume based (mL/kg body weight) (11/21; 52%) or a percentage of the volume of feed administered (6/21; 29%). Yet only a third of units provided guidance about the technique of gastric residual volume measurement.
CONCLUSIONS
Routine gastric residual volume measurement is part of standard practice in U.K. PICUs, with little guidance provided about the technique which may impact the accuracy of gastric residual volume. All PICUs that defined feed tolerance included gastric residual volume in the definition. This is important to know when proposing a standard practice arm of any future trial of no-routine gastric residual volume measurement in critically ill children.
目的
尽管证据有限，但在国际范围内，小儿重症监护病房（PICU）常规测量胃残余量以指导肠内喂养的启动和实施已广泛存在。鉴于对该实践相关证据的审查日益加强，作为一项试验可行性研究的一部分，我们旨在确定英国 PICU 的肠内喂养和胃残余量测量实践。
设计
对 27 家英国 PICU 进行在线调查。
设置
英国 PICU。
受试者
每家 PICU 的一名临床护士、一名高级医生和一名营养师受邀共同完成一份调查，并发送一份其单位关于肠内喂养和胃残余量的指南副本。
干预措施
无。
测量和主要结果
27 家 PICU 中有 24 家（89%）参与了调查。23 家单位（95.8%，23/24）有书面喂养指南，19 家单位（19/23，83%）发送了其指南以供审查。通过胃途径作为主要喂养方法，连续喂养（15/24；62%）的单位多于间歇性喂养（9/24；37%）。除一家 PICU 外，所有 PICU 均常规测量胃残余量，无论喂养方式如何。18 家单位有一致的喂养耐受定义，所有这些定义都包括胃残余量。喂养耐受的胃残余量阈值要么是基于体积（mL/kg 体重）（11/21；52%），要么是给予的喂养量的百分比（6/21；29%）。然而，只有三分之一的单位提供了胃残余量测量技术的指导。
结论
在英国 PICU 中，常规测量胃残余量是标准实践的一部分，关于该技术的指导很少，这可能会影响胃残余量的准确性。所有定义喂养耐受的 PICU 都将胃残余量纳入定义。当提出任何未来关于重症儿童不常规测量胃残余量的试验的标准实践臂时，这一点很重要。
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