Routine point-of-care ultrasound (POCUS) assessment of gastric antral content in traumatic emergency surgical patients for prevention of aspiration pneumonitis: an observational clinical trial

Mohamed S Shorbagy, Amr A Kasem, Ahmed A Gamal Eldin, Ramy Mahrose, Mohamed S Shorbagy, Amr A Kasem, Ahmed A Gamal Eldin, Ramy Mahrose

Abstract

Background: Polytrauma patients are at a higher risk of delayed gastric emptying. To assess the gastric volume, a reliable diagnostic tool is needed to prevent the occurrence of aspiration pneumonia, which remains a serious complication associated with anesthesia. Gastric antral ultrasound can provide reliable information about the size of the gastric antrum in traumatized patients undergoing emergency surgery.

Methods: A prospective observational study of 45 polytrauma patients undergoing emergency surgery under general anesthesia was carried out. Prior to induction of anesthesia in the emergency department, gastric ultrasound was performed for qualitative and quantitative assessment of the gastric antrum in a supine position and right lateral decubitus (RLD) position. This was followed by routine placement of the nasogastric tube to aspirate and calculate the volume of the stomach contents.

Results: Of the 45 polytrauma patients, the risk assessment of aspiration and the anesthesia technique changed in 14 patients (31.1%) after the gastric ultrasound examination. A very good relationship existed between the expected stomach volume at the RLD position and the suction volume in the nasogastric tube. In all cases, no aspirations were documented.

Conclusion: Ultrasound examination of the stomach in polytrauma patients allows assessing the size and type of stomach contents. The data obtained can influence the choice of anesthesia technique and reduce the risk of aspiration pneumonia.

Trial registration: This trial was registered at ClinicalTrials.gov . registry number: NCT04083677 on September 6, 2019.

Keywords: Aspiration pneumonia; Emergency surgery; Gastric ultrasound; Point of care; Polytrauma.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a Sagittal sonography of the gastric antrum. A = antrum; L = liver; P = pancreas; SMA = superior mesenteric artery; Ao = aorta. b Sagittal picture of the gastric antrum
Fig. 2
Fig. 2
Sagittal sonogram of the empty antrum with a flat appearance. A = antrum; L = liver; P = pancreas; SMA = superior mesenteric artery; Ao = aorta
Fig. 3
Fig. 3
Bull’s eye sign. L = liver; P = pancreas;. Ao = aorta
Fig. 4
Fig. 4
a Sagittal sonography of the gastric antrum immediately following the ingestion of 200 mL of the clear fluid (“starry night” appearance). A = antrum; L = liver; P = pancreas. b Axial A = antrum, D = duodenum, Py = pylorus, IVC = inferior vena cava, Ao = aorta
Fig. 5
Fig. 5
Frosted glass sign. A = antrum; L = liver; P = pancreas; Ao = aorta
Fig. 6
Fig. 6
Flow chart of the analysis of the findings and medical decision-making based on the gastric point-of-care ultrasound
Fig. 7
Fig. 7
Results of gastric ultrasound examination of gastric contents
Fig. 8
Fig. 8
Patient management

References

    1. Perlas A, Davis L, KNM M, Vincent WS, Chan VW. Gastric Sonography in the fasted surgical patient: a prospective descriptive study. Anesth Analg. 2011;113:39–37. doi: 10.1213/ANE.0b013e31821b98c0.
    1. Cubillos J, Cyrus T, Vincent WS, Chan VW, Perlas A. Bedside ultrasound assessment of gastric content: an observational study. Can J Anesth. 2012;59(4):416–423. doi: 10.1007/s12630-011-9661-9.
    1. Perlas A, Arzola C, Van de Putte P. Point-of-care gastric ultrasound and aspiration risk assessment: a narrative review. Anesthesiology. 2015;90:313–330.
    1. Bouvet L, Chassard J, Benhamou B. Clinical assessment of the ultrasound measurement of antral area for estimating preoperative gastric content and volume. Eur J Anaesthesiol. 2017;114:1086–1092. doi: 10.1097/ALN.0b013e31820dee48.
    1. Van de Putte P, Perlas A. Ultrasound assessment of gastric content and volume. Br J Anaesth. 2014;113(1):12–22. doi: 10.1093/bja/aeu151.
    1. Sabry R, Hasanin A, Refaat S, Abdel Raouf S, Abdallah AS, Helmy N. Evaluation of gastric residual volume in fasting diabetic patients using gastric ultrasound. Acta Anaesthesiol Scand. 2019;63(5):615–619. doi: 10.1111/aas.13315.
    1. Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol. 1946;52:191–205. doi: 10.1016/S0002-9378(16)39829-5.
    1. Levy DM. Pre-operative fasting-60 years on from Mendelson BJA Educ, continuing education in anesthesia. Crit Care Pain. 2006;6:2015–2018.
    1. Bisinotto FM, Pansani PL, Silveira LA, Naves AD, Peixoto AC, Lima HM, et al. Qualitative and quantitative ultrasound assessment of gastric content. Rev Assoc Méd Bras. 2017;63(2):134. doi: 10.1590/1806-9282.63.02.134.
    1. Arzola C, Perlas A, Siddiqui NT, Carvalho JC. Bedside gastric ultrasonography in term pregnant women before elective cesarean delivery: a prospective cohort study. Anesth Analg. 2015;121(3):752–758. doi: 10.1213/ANE.0000000000000818.
    1. Van de Putte P, Van Hoonacker J, Perlas A. Gastric ultrasound to guide anesthetic management in elective surgical patients non-compliant with fasting instructions. A retrospective cohort study. Minerva Anestesiol. 2018;84(7):787–795. doi: 10.23736/S0375-9393.17.12305-9.

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