RETRACTED ARTICLE: Routine point-of-care ultrasound (POCUS) assessment of gastric antral content in traumatic emergency surgical patients for prevention of aspiration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

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.

Pulmonary Aspiration During Procedural Sedation for Colonoscopy Managed With Two Endotracheal Tubes and A McGrath Laryngoscope

“…The fasting state may be unreliable in elderly people with poor awareness, in children, and in cases of delayed stomach emptying, as in patients with intestinal obstruction or multiple traumas [ 7 ]. A new prediction model for assessing gastric volume based on point of care sonographic measurements allows assessing the size and type of stomach contents [ 8 ]. Identifying high-risk patients by gastric ultrasound and performing preemptive gastric emptying by naso/orogastric tube reduces the risk of aspiration.…”

Point-of-Care Ultrasound for the Trauma Anesthesiologist

“…One observational study of 45 polytrauma patients who were scanned in supine and right lateral decubitus positions showed concordance between expected stomach volume and the volume suctioned in the right lateral decubitus (RLD) position. The authors noted no aspiration events occurred in these polytrauma patients, but they did not note if their assessments changed their anesthetic approach, which would be a medical decision-making goal of using this modality [ 38 •].…”

SP41 Indicators that pocus is here to stay for anaesthesiologists too!

“…It allows to personalize aspiration risk assessment and to tailor anesthetic management to the individual patient. [10][11][12][13][14] Lung POCUS has proven to be a valuable tool for the detection of pneumothorax, pleural effusion, consolidation and alveolar interstitial syndrome in the critical care setting, searching for signs like: Lung sliding (sliding of visceral and parietal pleura over one another with respiration), that may rule out pneumothorax, A lines (repeated parallel lines below pleura), suggesting that there is no parenchymal disease and B lines ( vertical lines) indicating fluid in the lungs or an interstitial syndrome. According to studies it seems to have comparable or even higher sensitivity and specificity than the chest x ray in diagnosing common lung pathologies as alveolar interstitial syndrome, consolidation, pleural effusion and pneumothorax.…”