Routine gastric residual volume measurement and energy target achievement in the PICU: a comparison study.
Routine gastric residual volume measurement and energy target achievement in the PICU: a comparison study.
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DOI：
10.1007/s00431-017-3015-8
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发表时间：
2017-12
影响因子：
3.6
通讯作者：
Valla FV
中科院分区：
文献类型：
--
作者：
Tume LN;Bickerdike A;Latten L;Davies S;Lefèvre MH;Nicolas GW;Valla FV
危重病患儿经常无法获得足够的能量摄入，一些护理实践，如测量胃残留量（GRV），可能会导致这个问题。我们比较了两个类似的欧洲儿科重症监护病房（PICU）的结局：一个常规测量GRV（PICU-GRV），另一个不测量GRV（PICU-noGRV）。进行了一项观察性试点比较研究。87名儿童被纳入研究，42名（PICU-GRV）和45名（PICU-noGRV）。PICU入院前4天达到的能量目标百分比无显著差异，尽管PICU-noGRV显示中位数（和IQR）能量目标的输送更一致，PICU-GRV和PICU-noGRV的喂养不足和过度喂养更少：第1天37（14-72）vs 44（0-100），第2天97（53-126）vs 100（100-100），第3天84（45-112）vs 100（100-100）和第4天101（63-124）vs 100（100-100）。PICU-GRV的呕吐发生率较高。两个单位均未证实坏死性小肠结肠炎，PICU-GRV和PICU-noGRV单位之间的呼吸机获得性肺炎发生率无显著差异（7.01 vs 12 5.31/1000呼吸机日; p = 0.70）。 结论：在PICU入院的前4天，常规胃残留量测量的做法并没有显着损害能量目标。然而，不测量GRV不会增加呕吐，呼吸机获得性肺炎或坏死性小肠结肠炎，这是临床医生引用测量GRV的主要原因。
Critically ill children frequently fail to achieve adequate energy intake, and some care practices, such as the measurement of gastric residual volume (GRV), may contribute to this problem. We compared outcomes in two similar European Paediatric Intensive Care Units (PICUs): one which routinely measures GRV (PICU-GRV) to one unit that does not (PICU-noGRV). An observational pilot comparison study was undertaken. Eighty-seven children were included in the study, 42 (PICU-GRV) and 45 (PICU-noGRV). There were no significant differences in the percentage of energy targets achieved in the first 4 days of PICU admission although PICU-noGRV showed more consistent delivery of median (and IQR) energy targets and less under and over feeding for PICU-GRV and PICU-noGRV: day 1 37 (14–72) vs 44 (0–100), day 2 97 (53–126) vs 100 (100–100), day 3 84 (45–112) vs 100 (100–100) and day 4 101 (63–124) vs 100 (100–100). The incidence of vomiting was higher in PICU-GRV. No necrotising enterocolitis was confirmed in either unit, and ventilator-acquired pneumonia rates were not significantly different (7.01 vs 12 5.31 per 1000 ventilator days; p = 0.70) between PICU-GRV and PICU-noGRV units. Conclusions: The practice of routine gastric residual measurement did not significantly impair energy targets in the first 4 days of PICU admission. However, not measuring GRV did not increase vomiting, ventilator-acquired pneumonia or necrotising enterocolitis, which is the main reason clinicians cite for measuring GRV.
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