Patient enrollment difficulties

Nearly half of critically ill children are intubated and enterally fed according to recent guidelines. However, no evidence-based recommendation are available regarding fasting times prior to extubation.

When an extubation is planned, children do not always present with normal neurological status yet, and are at risk of vomiting and aspiration. Extubation may also fail and require re-intubation with similar risks. Thus, pre-operative fasting guidelines are often transposed to the paediatric critical care setting, aiming for an empty stomach at extubation, with perceived decreased risks of aspiration. However, the gastric and gut motility pathophysiology is significantly different in critically ill children (frequent gastroparesis, liquid continuous feeding, etc.) compared to planned surgery children. The extrapolation of practice validated in the latter population may be inadequate. The stomach may be empty more or less rapidly than expected, leading to unnecessary prolonged fasting times or inappropriately short fasting times respectively.

Gastric ultrasounding monitoring may help assessing gastric content prior to extubation.

Investigators hypothesise gastric content clearance may be different in critically ill children prior to extubation, compared to pre-operative paediatric guidelines for elective surgery.

Inclusion Criteria:

• 0 to 17 year old children admitted to pediatric intensive care unit
• intubated (oral or nasal tracheal tube)
• gastric enteral feeding affording at least 25% of the nutritional target (estimated with Schofield equations)
• No opposition from one of the 2 parents (or legal representatives)

Exclusion Criteria:

• anatomical anomaly of the stomach location (e.g. post surgery)
• Difficult access to perform gastric ultra-sounding (drains, plasters, dressings etc.)
• mobilization to right lateral decubitus at risk

45 critically ill children (meeting inclusion criteria and respecting exclusion criteria), will be recruited in a single pediatric intensive care unit, if they are intubated and enterally fed on a gastric tube.