Reliability of gastric suctioning compared with ultrasound assessment of residual gastric volume: a prospective multicentre cohort study

L Bouvet, L Zieleskiewicz, E Loubradou, A Alain, J Morel, L Argaud, D Chassard, M Leone, B Allaouchiche, AzuRea CAR'Echo collaborative networks, L Bouvet, L Zieleskiewicz, E Loubradou, A Alain, J Morel, L Argaud, D Chassard, M Leone, B Allaouchiche, AzuRea CAR'Echo collaborative networks

Abstract

We aimed to compare the reliability of aspiration via a nasogastric tube with ultrasound for assessment of residual gastric volume. Sixty-one adult patients who were mechanically ventilated and received continuous enteral feeding through a nasogastric tube for > 48 h were included. A first qualitative and quantitative ultrasound examination of the gastric antrum was followed by gastric suctioning, performed by an operator blinded to the result of the ultrasound examination. A second ultrasound examination was performed thereafter, followed by re-injection of the aspirated gastric contents (≤ 250 ml) into the stomach. A third ultrasound assessment was then immediately performed. If the suctioned volume was ≥ 250 ml, 250 mg erythromycin was infused over 30 min. A fourth ultrasound was performed 90 min after the third. Sixty (98%) patients had a qualitatively assessed full stomach at first ultrasound examination vs. 52 (85%) after gastric suctioning (p = 0.016). The calculated gastric volume significantly decreased after gastric suctioning, without a significant decrease in the number of patients with volume ≥ 250 ml. Four of the nine patients with calculated gastric volume ≥ 250 ml had vomiting within the last 24 h (p = 0.013). The antral cross-sectional area significantly decreased between the third and the fourth ultrasound examination (p = 0.015). Erythromycin infusion did not make a significant difference to gastric volume (n = 10). Our results demonstrate that gastric suctioning is not a reliable tool for monitoring residual gastric volume. Gastric ultrasound is a feasible and promising tool for gastric volume monitoring in clinical practice.

Trial registration: ClinicalTrials.gov NCT03205592.

Keywords: critical illness; early enteral nutrition; gastric ultrasound; ventilator-associated pneumonia.

© 2019 Association of Anaesthetists.

References

    1. Mentec H, Dupont H, Bocchetti M, Cani P, Ponche F, Bleichner G. Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Critical Care Medicine 2001; 29: 1955-61.
    1. Gungabissoon U, Hacquoil K, Bains C, et al. Prevalence, risk factors, clinical consequences, and treatment of enteral feed intolerance during critical illness. Journal of Parenteral and Enteral Nutrition 2015; 39: 441-8.
    1. McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically Ill patient: society of critical care medicine (SCCM) and American society for parenteral and enteral nutrition (A.S.P.E.N.). Journal of Parenteral and Enteral Nutrition 2009; 33: 277-316.
    1. Metheny NA, Mills AC, Stewart BJ. Monitoring for intolerance to gastric tube feedings: a national survey. American Journal of Critical Care 2012; 21: e33-40.
    1. Taylor BE, McClave SA, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically Ill patient: society of critical care medicine (SCCM) and American society for parenteral and enteral nutrition (A.S.P.E.N.). Critical Care Medicine 2016; 44: 390-438.
    1. Reignier J, Mercier E, Le Gouge A, et al. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. Journal of the American Medical Association 2013; 309: 249-56.
    1. Kuppinger DD, Rittler P, Hartl WH, Ruttinger D. Use of gastric residual volume to guide enteral nutrition in critically ill patients: a brief systematic review of clinical studies. Nutrition 2013; 29: 1075-9.
    1. Elke G, Felbinger TW, Heyland DK. Gastric residual volume in critically ill patients: a dead marker or still alive? Nutrition in Clinical Practice 2015; 30: 59-71.
    1. Safdar N, Crnich CJ, Maki DG. The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention. Respiratory Care 2005; 50: 725-39.
    1. McClave SA, Lukan JK, Stefater JA, et al. Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Critical Care Medicine 2005; 33: 324-30.
    1. Bartlett Ellis RJ, Fuehne J. Examination of accuracy in the assessment of gastric residual volume: a simulated, controlled study. Journal of Parenteral and Enteral Nutrition 2015; 39: 434-40.
    1. Chastre J, Fagon JY. Ventilator-associated pneumonia. American Journal of Respiratory and Critical Care Medicine 2002; 165: 867-903.
    1. Bonten MJ. Ventilator-associated pneumonia and the gastropulmonary route of infection: a pendulum. American Journal of Respiratory and Critical Care Medicine 2011; 184: 991-3.
    1. Perlas A, Chan VW, Lupu CM, Mitsakakis N, Hanbidge A. Ultrasound assessment of gastric content and volume. Anesthesiology 2009; 111: 82-9.
    1. Bouvet L, Desgranges FP, Aubergy C, et al. Prevalence and factors predictive of full stomach in elective and emergency surgical patients: a prospective cohort study. British Journal of Anaesthesia 2017; 118: 372-9.
    1. Bouvet L, Mazoit JX, Chassard D, Allaouchiche B, Boselli E, Benhamou D. Clinical assessment of the ultrasonographic measurement of antral area for estimating preoperative gastric content and volume. Anesthesiology 2011; 114: 1086-92.
    1. Bouvet L, Chassard D. Contribution of ultrasonography for the preoperative assessment of gastric contents. Annales Françaises D'Anesthésie et de Réanimation 2014; 33: 240-7.
    1. Chatelon J, Bourillon C, Darmon H, et al. Feasibility and predictive value of ultrasound assessment of the gastric residual volume in surgical critically ill patients: a pilot study. Critical Care Medicine 2016; 44: e1255-7.
    1. Hamada SR, Garcon P, Ronot M, Kerever S, Paugam-Burtz C, Mantz J. Ultrasound assessment of gastric volume in critically ill patients. Intensive Care Medicine 2014; 40: 965-72.
    1. Sharma V, Gudivada D, Gueret R, Bailitz J. Ultrasound-assessed gastric antral area correlates with aspirated tube feed volume in enterally fed critically ill patients. Nutrition in Clinical Practice 2017; 32: 206-11.
    1. Leone M, Constantin JM, Dahyot-Fizelier C, et al. French intensive care unit organisation. Anaesthesia Critical Care and Pain Medicine 2018; 37: 625-7.
    1. Vandenbroucke JP, von Elm E, Altman DG, et al. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. PLoS Medicine 2007; 4: e297.
    1. Cubillos J, Tse C, Chan VW, Perlas A. Bedside ultrasound assessment of gastric content: an observational study. Canadian Journal of Anesthesia 2012; 59: 416-23.
    1. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307-10.
    1. Newton M, Burnham WR, Kamm MA. Morbidity, mortality, and risk factors for esophagitis in hospital inpatients. Journal of Clinical Gastroenterology 2000; 30: 264-9.
    1. Gagey AC, de Queiroz SM, Monard C, et al. The effect of pre-operative gastric ultrasound examination on the choice of general anaesthetic induction technique for non-elective paediatric surgery. A prospective cohort study. Anaesthesia 2018; 73: 304-12.
    1. Zieleskiewicz L, Bouvet L, Einav S, Duclos G, Leone M. Diagnostic point-of-care ultrasound: applications in obstetric anaesthetic management. Anaesthesia 2018; 73: 1265-79.
    1. Perlas A, Van de Putte P, Van Houwe P, Chan VW. I-AIM framework for point-of-care gastric ultrasound. British Journal of Anaesthesia 2015; 116: 7-11.
    1. Koenig SJ, Lakticova V, Mayo PH. Utility of ultrasonography for detection of gastric fluid during urgent endotracheal intubation. Intensive Care Medicine 2011; 37: 627-31.
    1. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. Journal of the American Medical Association 1993; 270: 2957-63.
    1. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Medicine 1996; 22: 707-10.

Source: PubMed

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