Should We Stop Checking Gastric Residual Volume in PICUs?

In pediatric intensive care units, clinicians frequently measure gastric residual volume to assess feeding tolerance. However, this common practice lacks strong clinical evidence. A landmark clinical trial published in JAMA now challenges this routine. Consequently, the GASTRIC-PICU trial shows that omitting this step is safe and improves nutrition.

Rethinking Gastric Residual Volume in Pediatric Care

Historically, pediatric nurses have checked gastric residual volume before administering enteral feeds. They do this to prevent vomiting and aspiration in ventilated children. Yet, this approach often leads to unnecessary feeding interruptions. Consequently, critically ill children receive insufficient nutrition during crucial recovery periods.

Key Findings from the GASTRIC-PICU Trial

The pragmatic, randomized trial evaluated 4,460 ventilated children across several intensive care units. Researchers assigned patients to either usual care or no routine monitoring. Interestingly, the group with no routine monitoring achieved better nutritional targets. Specifically, they met 80.3% of their energy requirements by 72 hours, compared to 76.8% in the usual care group. Furthermore, clinical outcomes like ventilator-free days and survival rates remained completely noninferior. Therefore, omitting routine checks safely increases calorie delivery without compromising safety.

Clinical Implications for Practice

These findings suggest that pediatric units should update their feeding protocols. Instead of relying on routine gastric residual volume measurements, clinicians should focus on physical symptoms of intolerance. For instance, abdominal distension, vomiting, and discomfort are more reliable indicators. This shift in practice will likely reduce feeding interruptions. As a result, critically ill children will recover faster with optimal nutritional support.

Frequently Asked Questions

Q1: Why is measuring gastric residual volume being questioned?

Traditionally, clinicians measured residual volume to prevent aspiration. However, this practice often causes unnecessary feeding delays, which ultimately limits essential calorie delivery to recovering children.

Q2: What did the GASTRIC-PICU trial discover about safety?

The study found that omitting routine checks was entirely safe. Specifically, there was no difference in survival or mechanical ventilation duration between the two groups.

Q3: How should clinicians assess feeding tolerance instead?

Instead of routine measurements, clinicians should rely on physical examinations. For example, they can monitor for clinical symptoms like abdominal distension, vomiting, or significant patient discomfort.

References

1. Tume LN et al. Gastric Residual Volume Assessment in Critically Ill Children: The GASTRIC-PICU Randomized Clinical Trial. JAMA. 2026 Jun 12. doi: 10.1001/jama.2026.10639. PMID: 42283228.
2. Tume LN et al. Protocol for a Randomized Clinical Trial to Evaluate Not Routinely Measuring Gastric Residual Volume to Guide Enteral Feeding Versus Routine Measurement in Mechanically Ventilated Critically Ill Children (GASTRIC-PICU). Pediatr Crit Care Med. 2026 Feb 26;27(5):655-665. doi: 10.1097/PCC.0000000000003921.