The edition · Emergency & Critical Care
Stop measuring gastric residual volumes in ventilated children
A 4,700-child noninferiority trial across 24 paediatric intensive care units found dropping routine six-hourly checks did no harm and improved feeding. Plus a negative trial of MRSA nares swabs for vancomycin de-escalation, a buprenorphine-naloxone licence supplement, lung ultrasound through the oesophagus, and what happens when home beta-blockers are held on admission.
The edition in brief
GASTRIC-PICU randomised 4,700 mechanically ventilated children in 23 UK and one Swiss paediatric intensive care units to routine six-hourly gastric residual volume assessment or no routine assessment, with feed tolerance judged clinically. Not measuring was noninferior for the composite of survival and ventilator-free days at 30 days (adjusted odds ratio 0.95, 95% CI 0.86-1.05) and improved the proportion of energy requirements met by 72 hours from 76.8% to 80.3%. STOP-Vanc randomised 277 adult intensive care patients with suspected community-acquired pneumonia to usual care with or without MRSA nasal PCR: the swab had a negative predictive value of 98.9% but made no difference to vancomycin-free hours alive, an adjusted difference of 4 hours (95% CI -9.5 to 18.2). The FDA has recorded a supplement to a generic buprenorphine and naloxone application held by Dr Reddy's Laboratories. In an observational registry of 379 resuscitative transoesophageal echocardiography studies in ventilated adults with shock, adding transoesophageal lung ultrasound raised operator-reported identification of the shock cause from 75.3% to 86.5% at the cost of about 2.5 minutes. A target trial emulation in 4,635 emergency department admissions with suspected infection found continuing chronic oral beta-blockers within 48 hours was associated with lower 90-day mortality (hazard ratio 0.77, 0.61-0.98). Two of these are randomised; the other two are observational and cannot establish cause.
GASTRIC-PICU: routine gastric residual checks can go
Stop routine six-hourly gastric residual volume assessment in ventilated children: it was noninferior for survival and ventilator-free days and children met their energy targets sooner without it.
A near-perfect test that changed no prescribing
MRSA nasal PCR reliably excludes MRSA pneumonia but did not by itself reduce vancomycin use — the test needs a de-escalation process attached to it.
Generic buprenorphine-naloxone supplement recorded by the FDA
The buprenorphine-naloxone entry is generic licence maintenance with no clinical consequence — the useful question is whether your department stocks it and has somewhere to refer.
Lung ultrasound through the oesophagus during resuscitative TEE
Adding lung views to resuscitative transoesophageal echocardiography is quick and safe and made operators more confident of the cause of shock — but no patient outcome was measured.
The lactate that matters is the second one
Judge lactate by its trend at two to four hours rather than by the first value, and treat a lactate that will not fall as a reason to reassess the diagnosis, not to give more fluid.
Holding the home beta-blocker on admission may not be the safe option
Continuing a patient's usual beta-blocker on admission with suspected infection was associated with lower 90-day mortality — enough to stop holding it by reflex in stable patients, not enough to make continuation a rule.
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