CompletedInterventional

No routine measurement of gastric residual volume in paediatric critical care

When seriously ill children are on a breathing machine in a paediatric intensive care unit (PICU), they often receive milk through a feeding tube. Currently in the UK, nurses regularly draw out stomach fluid every six hours using a syringe to check how full the stomach is. If there is a large amount of fluid, feeds are often paused. However, this check is not very accurate, meaning children often miss out on the vital energy they need to get better. The GASTRIC-PICU study is comparing two ways of caring for these children. Half the children will have routine syringe checks as usual. The other half will not have routine checks; instead, nurses will check whether feeds are tolerated using bedside examinations. The aim is to see if stopping routine checks safely helps children receive more nutrition and recover faster.

At a glance

Status

Completed

Sponsor

Intensive Care National Audit & Research Centre

Enrolment target

4,700

Start

29 Jun 2023

Estimated completion

07 Dec 2025

Oral and Gastrointestinal

What is this study about?

When children become very ill and need a breathing machine in intensive care, they cannot swallow food normally. Instead, they receive liquid food directly into their stomach through a soft tube placed in their nose or tummy. Getting enough energy and nutrition is vital during critical illness. It helps children heal wounds, fight off infections, and come off the breathing machine sooner.

At present, nurses in UK intensive care units routinely use a syringe to gently draw fluid out of the child's feeding tube at least every six hours. If they find a large amount of fluid, feeding is often stopped because of worries that the stomach is too full. However, research shows that this test is not very accurate. A full stomach can simply be caused by natural digestive juices or medicines that slow down the bowel. Because of these pauses, children in intensive care often receive only half of the calories they truly need.

The GASTRIC-PICU trial aims to find out if routine syringe checks are really necessary. In some countries, such as France, doctors do not routinely check stomach fluid and instead rely on normal bedside monitoring and physical examinations. This study will see if stopping routine checks helps UK children get more of their feeds safely without causing any harm.

Key takeaways

The trial tests whether skipping routine stomach fluid checks helps sick children receive more of their feeds.
Checking stomach fluid with a syringe often leads to feeding being paused when it does not need to be.
Children are randomly placed into either standard six-hourly checks or monitoring through physical signs alone.
The study involves no extra hospital visits, blood tests, or new medicines.
Taking part is voluntary, and you can withdraw your child at any stage without affecting their care.

Who may be eligible?

This study is for babies and children being cared for in a paediatric intensive care unit. To take part, children must be at least 37 weeks corrected age (born at full term or having reached their original due date) and under 16 years old. They must be on a mechanical breathing machine that is expected to stay in place for at least two more days, and they must be receiving or about to start tube feeds into their stomach.

Children cannot take part if their feeding tube goes past the stomach directly into the small intestine, or if they have had recent bowel surgery or serious gut conditions such as severe bowel inflammation or bleeding. Children who need long-term mechanical ventilation or who have an end-of-life care plan in place are also not eligible.

Could this study suit you?

Answer these quick questions to see if you may be eligible. This is a guide only — the research team makes the final call.

Child is between 37 weeks corrected age and under 16 years old
Child is currently in a paediatric intensive care unit
Child is on a breathing machine expected to be needed for at least 48 hours
Child is receiving or starting milk feeds directly into the stomach
Child has not had recent gut surgery or serious intestinal disease

Answer every question to see your result.

What does participation involve?

If a child joins the study, a computer will place them into one of two groups by chance. One group will receive standard care, with nurses checking stomach fluid through the feeding tube at least every six hours. The other group will not have routine stomach fluid checks; instead, nurses will check the child's tummy and monitor for any signs that food is not being digested well. Taking part does not require any extra hospital visits, blood tests, or new medications. The study simply changes how the feeding tube is monitored while the child is on the breathing machine in the intensive care unit.

Potential risks and benefits

Children who do not have routine fluid checks may receive more of their daily feeds, which could help them recover faster and leave the breathing machine sooner. A possible risk of not checking fluid is that the stomach could become too full, potentially causing vomiting. However, drawing fluid out and returning it during standard care can also trigger sickness, and previous studies have found no added safety risks when routine checks were stopped. The intensive care team will monitor your child round the clock regardless of their group. You can choose to withdraw your child from the study at any time without their care being affected.

Locations (21)

Cambridge University Hospitals NHS Foundation Trust
City only
Cambridge, England
University Hospitals Bristol and Weston NHS Foundation Trust
City only
Bristol, England
Guy's and St Thomas' NHS Foundation Trust
City only
London, England
Great Ormond Street Hospital for Children
Approximate
London, England
Leicester Royal Infirmary
Approximate
Leicester, England
Manchester University NHS Foundation Trust
Unverified
Manchester, England
Freeman Road Hospital
Unverified
Newcastle upon Tyne, England
John Radcliffe Hospital
Unverified
Oxford, England
Southampton General Hospital
Unverified
Southampton, England
St Georges Hospital
Unverified
London, England
Imperial College Healthcare NHS Trust
Unverified
London, England
NHS Greater Glasgow and Clyde
Unverified
Glasgow, Scotland

Common questions

Will taking part change my child's general intensive care treatment?

No. All of your child's medicines, breathing support, and standard medical treatments will continue exactly as planned by their clinical team.

Can I choose which group my child is placed in?

No. A computer randomly decides which group your child joins. This helps ensure the study results are fair and reliable.

Is the study painful or uncomfortable for my child?

No. The feeding tube is already in place, and taking part does not involve any painful procedures or injections. Not having regular syringe checks may even cause less disturbance.

How will nurses know if my child is not tolerating their feed?

Nurses constantly watch intensive care patients. They will gently feel your child's tummy, check for swelling, and look for any signs of discomfort or sickness.

What happens if I change my mind later on?

You can withdraw your child from the study at any time. Your decision will never alter the high level of care and support your child receives.

How to find out more

GASTRIC-PICU Team

gastric@icnarc.org - Official trial record

Always speak to your GP or specialist before deciding to take part in a study.