A major paediatric intensive care study led by Professor Lyvonne Tume, professor of Critical Care Nursing and Chief Investigator for the study, has found that critically ill children receiving breathing support may not need routine stomach content checks to guide their feeding.
The findings from the GASTRIC-PICU trial have now been published in JAMA, one of the world’s leading medical journals.
The trial explored whether routine gastric residual volume checks are needed for children in paediatric intensive care (PICU) who are receiving breathing support from a ventilator and being fed through a tube.
These checks involve removing a small amount of fluid from a child’s stomach through their feeding tube. Clinical teams use this to assess how much feed remains in the stomach before deciding whether feeding should continue.
The practice has been widely used in children’s intensive care for many years, but there has previously been limited evidence to show whether it benefits children.
The trial involved 4,700 children aged from birth to 16 years from 23 paediatric intensive care units in the UK and one in Switzerland, making it the largest study of its kind conducted internationally.
Children were randomly placed into one of two groups. One group received usual care, with their stomach contents checked at least every six hours. The other group did not receive routine checks to guide their feeding.
The findings showed that children did just as well when the routine checks were not carried out. There was no difference in the number of days children were able to live without breathing support from a ventilator during the first 30 days.
More children who did not receive the routine checks also reached their nutrition targets within the first 72 hours of their care.
The study found no significant differences in important safety outcomes, including vomiting that caused feeding to be stopped, pneumonia associated with the use of a ventilator or a serious condition that can cause inflammation and damage to the bowel.
Professor Lyvonne Tume said:
“Research challenges the things we do every day and asks whether they are still the best approach for children.
“Feeding and nutrition are incredibly important for critically ill children, but unnecessary interruptions can make it more difficult for them to receive the nutrition they need.
“This research challenges a routine practice that has been used in paediatric intensive care for many years. Feeding and nutrition are incredibly important for critically ill children, but we know that unnecessary interruptions can make it harder for children to receive the nutrition they need.
“The GASTRIC-PICU trial provides strong evidence that routinely checking stomach contents does not improve key outcomes and may reduce the amount of nutrition children receive early in their care.
“These findings could help intensive care teams safely move away from a practice that may no longer be needed, while supporting better nutritional care for critically ill children.”
The study demonstrates why it is important for researchers to examine everyday clinical practices, including those that may have become routine over time.
By asking whether an intervention is still necessary, research can help reduce unnecessary procedures, improve children’s experiences and give clinical teams strong evidence on which to base decisions about their care.
The trial supports Alder Hey’s ambition to place research at the heart of children’s healthcare. By involving children and families in high-quality studies, research teams can challenge established practice, build stronger evidence and continue improving care for children and young people.
The GASTRIC-PICU trial was funded by the National Institute for Health and Care Research Health Technology Assessment programme.
Read the full publication here