A UK and Irish survey of enteral nutrition practices in paediatric intensive care units

Abstract

The aim of the present study was to describe the present knowledge of healthcare professionals and the practices surrounding enteral feeding in the UK and Irish paediatric intensive care unit (PICU) and propose recommendations for practice and research. A cross-sectional (thirty-four item) survey was sent to all PICU listed in the Paediatric Intensive Care Audit Network (PICANET) database (http://www. picanet.org.uk) in November 2010. The overall PICU response rate was 90 % (27/30 PICU; 108 individual responses in total). The overall breakdown of the professional groups was 59 % nursing staff (most were children's nurses), 27 % medical staff, 13 % dietitians and 1 % physician assistants. Most units (96 %) had some written guidance (although brief and generic) on enteral nutrition (EN); 85 % of staff, across all professional groups (P¼ 0·672), thought that guidelines helped to improve energy delivery in the PICU. Factors contributing to reduced energy delivery included: fluid-restrictive policies (60 %), the child just being 'too ill' to feed (17 %), surgical post-operative orders (16 %), nursing staff being too slow in starting feeds (7 %), frequent procedures requiring fasting (7 %) and haemodynamic instability (7 %). What constituted an 'acceptable' level of gastric residual volume (GRV) varied markedly across respondents, but GRV featured prominently in the decision to both stop EN and to determine feed tolerance and was similar for all professional groups. There was considerable variation across respondents about which procedures required fasting and the duration of this fasting. The present survey has highlighted the variability of the present enteral feeding practices across the UK and Ireland, particularly with regard to the use of GRV and fasting for procedures. The present study highlights a number of recommendations for both practice and research.

A review of feeding intolerance in critically ill children

“…We did not formally appraise the quality of these papers, as our aim was to describe the definition and use of the term feeding intolerance. A further 32 papers were review or discussion papers [n = 6] [2, 6,13,18,46,47], surveys [n = 5] [16,40,41,43,44], research papers which support this review but are not included in papers which defined feeding intolerance [n = 19] [3, 8, 11, 12, 14, 15, 17, 24, 25, 27, 30-32, 36, 38, 39, 42, 49], and guidelines [n = 2] [4,26] where feeding intolerance was mentioned or discussed.…”

“…Definitions of feeding intolerance in critically ill patients found in the literature search Surveys of PICU healthcare professionals (nurses, physicians, and dieticians) reveal a number of commonly used signs and symptoms to define feeding intolerance [16,40,43,44]. These include gastric residual volumes (GRV), vomiting, diarrhea, abdominal distention and pain/discomfort, and the use of serum lactate [41,46].…”

“…Gastric residual volume used as a surrogate marker of gastric emptying is used extensively in a majority of intensive care units (neonatal, pediatric, and adult) [6,13,40,44,46]. However, the evidence for it as a valid marker of gastric emptying is not supported [21].…”

Risk Factors for Delayed Enteral Nutrition in Critically Ill Children*

“…It is interesting that this risk factor is not consistently described as a threat to achieving full EN (12, 18). In fact, PICU caregivers have acknowledged a greater reluctance to start EN for patients who are “too ill” than those frankly “hemodynamically unstable” (25). This attitude is reflected in our study in which severity of illness, but not vasopressor use, was associated with delayed EN.…”

An Electronic Delphi Study to Establish Pediatric Intensive Care Nursing Research Priorities in Twenty European Countries*

“…The nursing science section was established and one of its aims was to establish the nursing research agenda within Europe. The current problem within European PIC nursing is that although there are a number of active research groups (5)(6)(7), there are no formal collaborative links or any known consensus of research priorities to allow further development of PIC nursing science across Europe. Therefore, it is imperative that the PIC nursing research priorities within Europe are defined.…”