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Gastric Emptying in Critically Ill Children
Enid E Martinez1,2,3, Luis M Pereira2,3, Kathleen Gura4
11 Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
Delayed gastric emptying (GE) is common in critically ill children and hinders enteral nutrition (EN) delivery. Current bedside assessments, including gastric residual volume (GRV), do not reliably predict delayed GE or EN advancement.
Area of Science:
- Pediatric critical care medicine
- Gastroenterology
- Nutritional support
Background:
- Delayed gastric emptying (GE) is a significant challenge in delivering enteral nutrition (EN) to critically ill children.
- Accurate assessment of GE and its impact on EN delivery is crucial for optimizing patient care.
Purpose of the Study:
- To investigate the correlation between bedside enteral nutrition (EN) intolerance assessments (including gastric residual volume - GRV), delayed GE, and delayed EN advancement in critically ill children.
- To evaluate the predictive value of current clinical assessments for delayed GE and EN delivery.
Main Methods:
- Prospective enrollment of pediatric patients (≥1 year) receiving gastric EN.
- Gastric emptying assessed using the acetaminophen absorption test (AUC60).
- EN intolerance assessments (GRV, abdominal distension, emesis, etc.) and EN advancement rates were recorded.
Main Results:
- 80% of enrolled patients exhibited delayed GE.
- Delayed GE was found to be a significant predictor of slow EN advancement (P = .0012).
- Bedside EN intolerance assessments, particularly GRV, did not correlate with delayed GE or the rate of EN advancement.
Conclusions:
- Delayed GE is prevalent in critically ill children and directly impacts EN delivery.
- Current bedside assessments, including GRV, are insufficient for predicting delayed GE or slow EN advancement.
- Development of novel diagnostic tools for GE and EN intolerance is warranted.
Background:
Delayed gastric emptying (GE) impedes enteral nutrient (EN) delivery in critically ill children. We examined the correlation between (a) bedside EN intolerance assessments, including gastric residual volume (GRV); (b) delayed GE; and (c) delayed EN advancement.
Materials And Methods:
We prospectively enrolled patients ≥1 year of age, eligible for gastric EN and without contraindications to acetaminophen. Gastric emptying was determined by the acetaminophen absorption test, specifically the area under the curve at 60 minutes (AUC60). Slow EN advancement was defined as delivery of <50% of the prescribed EN 48 hours after study initiation. EN intolerance assessments (GRV, abdominal distension, emesis, loose stools, abdominal discomfort) were recorded.
Results:
We enrolled 20 patients, median 11 years (4.4-15.5), 50% male. Sixteen (80%) patients had delayed GE (AUC60 <600 mcg·min/mL) and 7 (35%) had slow EN advancement. Median GRV (mL/kg) for patients with delayed vs normal GE was 0.43 (0.113-2.188) vs 0.89 (0.06-1.91), P = .9635. Patients with slow vs rapid EN advancement had median GRV (mL/kg) of 1.02 mL/kg (0.20-3.20) vs 0.27 mL/kg (0.06-1.62), P = .3114, and frequency of altered EN intolerance assessments of 3/7 (42.9%) vs 5/13 (38.5%), P = 1. Median AUC60 for patients with slow vs rapid EN advancement was 91.74 mcg·min/mL (53.52-143.1) vs 449.5 mcg·min/mL (173.2-786.5), P = .0012.
Conclusions:
A majority of our study cohort had delayed GE. Bedside EN intolerance assessments, particularly GRV, did not predict delayed GE or rate of EN advancement. Delayed gastric emptying predicted slow EN advancement. Novel tests for delayed GE and EN intolerance are needed.
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