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

Abstract

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.

The most practical diagnostic imaging for detecting body packers during the drug trafficking: Ultrasonography

“…17 However, plain abdominal radiography still needs to be improved in making the diagnosis. 18 A review by Valla et al 19 showed that, compared to x-ray, gastric POCUS could be used to confirm the presence of a foreign body. This is due to the low efficacy of plain abdominal radiography, especially in detecting the presence of a nonradio-opaque foreign body.…”

Biomarkers and Functional Assays of Epithelial Barrier Disruption and Gastrointestinal Dysmotility in Critical Illness—A Narrative Review

“…Gastric point of care ultrasound (POCUS) is another non-invasive technique with wider potential applicability in the ICU. Gastric US has been studied in healthy pediatric cohorts, the perioperative setting, and in premature and full-term neonates [ 40 ]. Assessments of gastric contents, gastric volume, and the antral cross-sectional area have all been considered [ 40 ].…”

“…Gastric US has been studied in healthy pediatric cohorts, the perioperative setting, and in premature and full-term neonates [ 40 ]. Assessments of gastric contents, gastric volume, and the antral cross-sectional area have all been considered [ 40 ]. Fewer studies have been performed in the pediatric ICU.…”

Point-of-Care Ultrasound of a Pediatric Gastric Trichobezoar

“…14 A scoping review of gastric POCUS in children mentions the potential for emergency physicians to diagnose intragastric tricobezoar with POCUS. 15 However, there are no cases to date demonstrating the utility of POCUS for diagnosis of a gastric trichobezoar in a pediatric patient. Ultrasound diagnosis of bezoars in the pediatric population is especially important to limit exposure to radiation from other radiographic modalities including barium studies and CT scans.…”

“…There have been several cases in the literature demonstrating the utility of ultrasound for diagnosis of trichobezoars by radiologists, 1,9,11–13 and ultrasound has also been used in a Gastroenterology Unit to confirm the diagnosis in a 20-year-old patient with a history of trichophagia presenting with vomiting and abdominal pain 14 . A scoping review of gastric POCUS in children mentions the potential for emergency physicians to diagnose intragastric tricobezoar with POCUS 15 . However, there are no cases to date demonstrating the utility of POCUS for diagnosis of a gastric trichobezoar in a pediatric patient.…”