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Gastric Emptying in Critically Ill Children.

Enid E Martinez^1,2,3, Luis M Pereira^2,3, Kathleen Gura⁴

¹1 Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.

JPEN. Journal of Parenteral and Enteral Nutrition

|January 7, 2017

Summary

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.

Keywords:

critical care delayed enteral nutrition enteral nutrition enteral nutrition intolerance gastric emptying gastric residual volume pediatrics

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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.