Role of gastric ultrasound to guide enteral nutrition in the critically ill

Abstract

Purpose of reviewEarly initiation of enteral nutrition (EN) is often not feasible due to the high prevalence of gastrointestinal dysfunction that constitutes one of the leading nonavoidable causes for discontinuing or delaying enteral feeding in critically ill. This review summarizes current evidence on the role of gastric ultrasound as a management and monitoring tool for enteral nutrition in critically ill patients.Recent findingsThe ultrasound meal accommodation test, the gastrointestinal and urinary track sonography (GUTS), and other gastric ultrasound protocols used to diagnose and treat gastrointestinal dysfunction in critically ill patients have not changed the outcome. However, this intervention could help clinicians with accurate daily clinical decisions. The dynamic changes in the cross-sectional area (CSA) diameter could help to access gastrointestinal dynamics results immediately, provide a valuable guide to initiate EN, predict feeding intolerance (FI), and aid in following treatment response. More studies are necessary to determine the complete scope and true added clinical value of these tests in critically ill patients.SummaryUsing gastric point of care ultrasound (POCUS) is a noninvasive, radiation-free, and inexpensive method. Implementing the ultrasound meal accommodation test in ICU patients might become a step forward to ensure safe early enteral nutrition in critically ill patients.

Applications of Point-of-Care-Ultrasound in Neonatology: A Systematic Review of the Literature

“…Further abdominal POCUS applications include aiding in gastric evaluation, such as determining gastric emptying, content, and volume, which is crucial for assessing the risk of pulmonary aspiration during sedation. Gastric volumes equal to or less than 1.25 mL/kg in children are considered a low aspiration risk [ 21 , 53 , 54 ]. Abdominal POCUS also serves as a guide for enteral nutrition in intensive care unit patients, allowing for the management and monitoring of feeding, prediction of feeding intolerance by ultrasound meal accommodation test, and assessment of treatment response by examining gastrointestinal dynamics like gastrointestinal diameter, mucosal thickness, peristalsis, gastric residual volume, and blood flow [ 53 ].…”

“…Gastric volumes equal to or less than 1.25 mL/kg in children are considered a low aspiration risk [ 21 , 53 , 54 ]. Abdominal POCUS also serves as a guide for enteral nutrition in intensive care unit patients, allowing for the management and monitoring of feeding, prediction of feeding intolerance by ultrasound meal accommodation test, and assessment of treatment response by examining gastrointestinal dynamics like gastrointestinal diameter, mucosal thickness, peristalsis, gastric residual volume, and blood flow [ 53 ]. Furthermore, it facilitates investigations of gastric foreign bodies, assists in diagnosing conditions like hypertrophic pyloric stenosis, and is essential for monitoring gastric insufflation during mechanical ventilatory support [ 54 ].…”

“…Major organ abnormalities [15,24] Intraabdominal and pelvic free fluid [2,15,22,24,25,31,36,50] Bowel/gut perforation [24,31] Ascites [2,8,24,36] Mesenteric blood flow/ischemia [2,17,22,31] Neonatal ileus [18,51] Necrotizing enterocolitis [2,18,21,22,24,36,50,51] Meconium peritonitis [51] Incarcerated inguinal hernia [51] Intussusception [52] Volvulus [17,51] Renal blood flow [17] Gastric emptying, content, and volume; risk assessment of pulmonary aspiration during sedation [14,21,53,54] Guiding of enteral nutrition [53] Ultrasound meal accommodation test [53] Evaluation of gastrointestinal integrity [24,53] Gastric foreign body investigation [54] Hypertrophic pyloric stenosis diagnosis [54] Gastric insufflation during mechanical ventilatory support…”

Gastrointestinal function in critically ill patients

“…Such technologies could bring new knowledge on real-time changes of gastric motility in reaction to medications (e.g., opioids or prokinetics) and enteral nutrition [32]. Gastric ultrasound is increasingly used to assess gastric emptying in anesthesia and intensive care [33][34][35]. Some development is also reported in point-of-care ultrasound assessment of certain intestinal pathologies and abdominal venous congestion [36,37].…”