Draw back the stomach contents, measure, and hold the feed if the number looks big. It has been routine in paediatric intensive care for decades. But does gastric residual volume tell us anything useful?
In this episode of the eCritCare Podcast, Dr Swapnil Pawar is joined by Professor Lyvonne Tume, Professor of Critical Care Nursing and Chief Investigator of the GASTRIC-PICU trial, published in JAMA in 2026. GASTRIC-PICU randomised 4,700 mechanically ventilated children across 23 UK paediatric ICUs and one in Switzerland to routine gastric residual volume (GRV) measurement, or no routine measurement with feed tolerance assessed on clinical signs.
In this conversation:
Why GRV is such an unreliable number: syringe size, tube lumen, tip position, patient position and breast milk that clumps
Why clinicians asked for proof it was safe to stop, and how that forced a non-inferiority design
Choosing survival and ventilator-free days over VAP as the primary outcome, and the role of PICANet
Sample size, crossover and why per-protocol power matters in a non-inferiority trial
Strict non-adherence rules, the bedside education package, and the process evaluation that was cut
The results: non-inferior on clinical outcomes, better early nutrition, and far fewer feeds stopped for a "high" GRV
Why better nutrition did not shift ventilator days, and the hidden cost in long-stay complex children
Cardiac and ECMO patients, generalisability to Australia, and why low and middle income settings differ
A message for adult intensivists: de-implementation, not another trial
Three months on: attitude change, guideline change and an aggressive implementation plan
What comes next: reducing unnecessary fasting in PICU
Read this episode on Substack: https://critcareedu.substack.com/p/gastric-picu-trial-gastric-residual-volume
Paper: Tume LN, Mouncey PR, Broomhall JM, et al. Gastric Residual Volume Assessment in Critically Ill Children: The GASTRIC-PICU Randomized Clinical Trial. JAMA. 2026. doi:10.1001/jama.2026.10639
Please send us your feedback @ icuprimaryprepcast@gmail.com
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