Routine Point of Care Ultrasound (POCUS) Assessment of Gastric Antral Contents in Traumatic Emergency Surgical Patients for Prevention of Aspiration Pneumonitis: A Randomized Clinical Trial 

Abstract

Background: Polytrauma patients are at a higher risk of delayed gastric emptying. To assess 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. Prior to induction of anesthesia in the emergency department, gastric ultrasound was performed to allow qualitative and quantitative assessment of gastric antrum in a supine position and right lateral decubitus (RLD) position. Followed by routine placement of nasogastric tube to aspirate and calculate the volume of the stomach contents.Results: Forty-five polytrauma patients who underwent gastric ultrasound examination showed that the risk assessment of aspiration and anesthesia technique changed in 14 patients (31.1%) after the 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 while inducing anesthesia and reduce the risk of aspiration pneumonia.Trial registration: This trial was registered at ClinicalTrials.gov. Registry number: NCT04083677.