Does Point-of-Care Gastric Ultrasound Correlate With Reported Fasting Time?

Miller, Andrew F.; Levy, Jason A.; Krauss, Baruch; Gravel, Cynthia A.; Vieira, Rebecca L.; Neuman, Mark I.; Monuteaux, Michael C.; Rempell, Rachel

doi:10.1097/pec.0000000000001997

Cited by 7 publications

(8 citation statements)

References 23 publications

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Section: Discussionmentioning

confidence: 99%

“…In our cohort of children with acute appendicitis, gastric contents were not associated with the duration of fasting or abdominal pain. Recent ultrasound studies have likewise reported a poor correlation between gastric contents and fasting time in acutely ill children, both in the emergency department [21–23] and in the operating theatre [9]. However, other potential risk‐factors such as the presence of local complications and pre‐operative administration of opioid analgesics could not be analysed using multivariable regression given the limited numbers of patients.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound assessment of gastric contents in children before general anaesthesia for acute appendicitis

et al. 2022

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Summary There is increasing evidence that a minority of adults with acute appendicitis have gastric contents, posing an increased risk of pulmonary aspiration. This study aimed to evaluate the proportion of children with acute appendicitis who have gastric contents considered to pose a higher risk of pulmonary aspiration. We analysed point‐of‐care gastric ultrasound data routinely collected in children before emergency appendicectomy in a specialist paediatric hospital over a 30‐month period. Based on qualitative and quantitative antral assessment in the supine and right lateral decubitus positions, gastric contents were classified as ‘higher‐risk’ (clear liquid with calculated gastric fluid volume > 0.8 ml.kg−1, thick liquid or solid) or ‘lower‐risk’ of pulmonary aspiration. The 115 children studied had a mean (SD) age of 11 (3) years; 37 (32%; 95%CI: 24–42%) presented with higher‐risk gastric contents, including 15 (13%; 95%CI: 8–21%) with solid/thick liquid contents. Gastric contents could not be determined in 13 children as ultrasound examination was not feasible in the right lateral decubitus position. No cases of pulmonary aspiration occurred. This study shows that gastric ultrasound is feasible in children before emergency appendicectomy. This technique showed a range of gastric content measurements, which could contribute towards defining the risk of pulmonary aspiration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ultrasound assessment of gastric contents in children before general anaesthesia for acute appendicitis

et al. 2022

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“…In fasting children planned for elective surgery, gastric content volume was low ( 79 ) and the percentage of “stomachs at risk of aspiration” was 1% ( 2 ), but in the emergency setting, Gagey et al and Evain et al reported the incidence of full stomach to be between 51 and 37%, respectively ( 27 , 31 , 32 ). In children, fasting for more than 6 h admitted to the ED and requiring procedural sedation, 18–69% of these had a full stomach ( 6 , 37 , 41 ). Gagey et al reported that an ultrasound-guided anesthetic strategy led to an 85% appropriate induction sequence technique compared to 49% after clinical assessment alone in non-elective children ( 31 ).…”

Section: Gastric Emptyingmentioning

confidence: 99%

Gastric Point-of-Care Ultrasound in Acutely and Critically Ill Children (POCUS-ped): A Scoping Review

et al. 2022

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IntroductionPoint-of-care ultrasound (POCUS) use is increasing in pediatric clinical settings. However, gastric POCUS is rarely used, despite its potential value in optimizing the diagnosis and management in several clinical scenarios (i.e., assessing gastric emptying and gastric volume/content, gastric foreign bodies, confirming nasogastric tube placement, and hypertrophic pyloric stenosis). This review aimed to assess how gastric POCUS may be used in acute and critically ill children.Materials and MethodsAn international expert group was established, composed of pediatricians, pediatric intensivists, anesthesiologists, radiologists, nurses, and a methodologist. A scoping review was conducted with an aim to describe the use of gastric POCUS in pediatrics in acute and critical care settings. A literature search was conducted in three databases, to identify studies published between 1998 and 2022. Abstracts and relevant full texts were screened for eligibility, and data were extracted, according to the JBI methodology (Johanna Briggs Institute).ResultsA total of 70 studies were included. Most studies (n = 47; 67%) were conducted to assess gastric emptying and gastric volume/contents. The studies assessed gastric volume, the impact of different feed types (breast milk, fortifiers, and thickeners) and feed administration modes on gastric emptying, and gastric volume/content prior to sedation or anesthesia or during surgery. Other studies described the use of gastric POCUS in foreign body ingestion (n = 6), nasogastric tube placement (n = 5), hypertrophic pyloric stenosis (n = 8), and gastric insufflation during mechanical ventilatory support (n = 4). POCUS was performed by neonatologists, anesthesiologists, emergency department physicians, and surgeons. Their learning curve was rapid, and the accuracy was high when compared to that of the ultrasound performed by radiologists (RADUS) or other gold standards (e.g., endoscopy, radiography, and MRI). No study conducted in critically ill children was found apart from that in neonatal intensive care in preterms.DiscussionGastric POCUS appears useful and reliable in a variety of pediatric clinical settings. It may help optimize induction in emergency sedation/anesthesia, diagnose foreign bodies and hypertrophic pyloric stenosis, and assist in confirming nasogastric tube placement, avoiding delays in obtaining confirmatory examinations (RADUS, x-rays, etc.) and reducing radiation exposure. It may be useful in pediatric intensive care but requires further investigation.

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“…[47][48][49][50][51] Additionally, gastric POCUS has been used to assess stomach content in critically-ill ICU patients 52,53 and more recently in emergency department patients. [54][55][56][57][58] Importantly, although the Perlas Model is now being used to evaluate gastric content in these settings, the applicability and implication of the model's assigned "risk" categories outside of the anesthesia arena are entirely unknown, although for the sake of consistency with prior literature, we will continue to use the model's terminology.…”

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confidence: 99%

Point-of-Care Ultrasound to Assess Gastric Content in Pediatric Emergency Department Procedural Sedation Patients

Moake¹,

Presley²,

Hill³

et al. 2020

Pediatr Emer Care

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Objectives: There is debate regarding the timing of procedural sedation and analgesia (PSA) in relation to fasting status. Point-of-care ultrasound (POCUS) provides the ability to measure gastric content and is being used as a surrogate for aspiration risk in anesthesia. We sought to evaluate the gastric content of pediatric emergency department (PED) patients undergoing PSA using POCUS. Methods:We performed a prospective observational study using a convenience sample of pediatric patients undergoing PSA between July 1, 2018, and June 30, 2019. Following a brief history, gastric content was measured using POCUS in both supine and right lateral decubitus positions at 2-hour intervals until the time of PSA. Qualitative content and calculated volume were classified based on the Perlas Model of anesthesia "Risk" assessment.Results: Ninety-three patients were enrolled with 61.3% male and mean age of 6.5 years. Gastric content was determined in 92 patients. There were 79.3% that had "high risk" content at the time of PSA, with a median fasting time of 6.25 hours and no serious adverse events. Fasting duration had a weak to moderate ability to predict "risk" category (area under the curve = 0.73), with no patient (n = 17) who underwent multiple evaluations awaiting PSA progressing from "high" to "low risk." Conclusions:The majority of PED patients undergoing PSA at our institution had "high risk" gastric content with no clinically significant change occurring during serial evaluations. This calls into question the utility of delaying PSA based upon fasting status and lends support to a more comprehensive risk-benefit approach when planning pediatric PSA.

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Does Point-of-Care Gastric Ultrasound Correlate With Reported Fasting Time?

Cited by 7 publications

References 23 publications

Ultrasound assessment of gastric contents in children before general anaesthesia for acute appendicitis

Ultrasound assessment of gastric contents in children before general anaesthesia for acute appendicitis

Gastric Point-of-Care Ultrasound in Acutely and Critically Ill Children (POCUS-ped): A Scoping Review

Point-of-Care Ultrasound to Assess Gastric Content in Pediatric Emergency Department Procedural Sedation Patients

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