-
1.
Evaluation of gastric residual volume in fasting diabetic patients using gastric ultrasound.
Sabry, R, Hasanin, A, Refaat, S, Abdel Raouf, S, Abdallah, AS, Helmy, N
Acta anaesthesiologica Scandinavica. 2019;(5):615-619
Abstract
BACKGROUND Diabetic patients are claimed to have high risk of delayed gastric emptying; however, the evidence concerning residual gastric volume in fasting diabetic patients is not consistent. The aim of this work is to evaluate residual gastric volume in fasting diabetic patients for elective surgery. METHODS Fifty patients scheduled for elective surgery under general anaesthesia were included in the study. The study included 25 patients with at least 6-year history of diabetes and 25 healthy controls. Gastric ultrasound was performed to measure antral cross-sectional area in semi-sitting and right lateral positions. Nasogastric tube was inserted after induction of anaesthesia to aspirate and calculate the volume of gastric contents. Both study groups were compared according to antral cross-sectional area, residual gastric volume, risk of aspiration, in addition to demographic data. RESULTS The diabetic group showed higher median (quartiles) antral cross-sectional area (13.8 [9.5-19.5] mm2 versus 8.8 [5.5-10.5] mm2 , P < 0.001), and higher calculated gastric residual volume, (177 [96-275] mL versus 83 [50-109] mL, P < 0.001) compared to the control group. The diabetic group also showed higher aspirated volume through the nasogastric tube compared to the control group (150 [85-210] mL versus 75 [35-87] mL, P < 0.001). The correlation was very good between calculated residual gastric volume using ultrasound measures and volume of aspirated gastric contents through nasogastric tube. CONCLUSION Patients with long standing diabetes showed higher residual gastric volume compared to healthy controls after fasting 8 hours for elective surgery.
-
2.
The Use of Ultrasonography for Verifying Gastric Tube Placement in Newborns.
Dias, FSB, Alvares, BR, Jales, RM, Franco, APV, Silva, JEFD, Fabene, SMS, Caldas, JPS, Carmona, EV
Advances in neonatal care : official journal of the National Association of Neonatal Nurses. 2019;(3):219-225
Abstract
BACKGROUND The use of gastric tubes in newborns admitted to a neonatal intensive care unit is fairly high, and there is a risk of serious complications related to this procedure. PURPOSE Considering the need to find a method that does not involve the patient's exposure to radiation, this study aimed to evaluate the diagnostic accuracy of ultrasonography for verifying gastric tube placement in newborns. METHODS This was a prospective, double-blind, observational study performed in a neonatal intensive care unit, in which 159 infants had gastric intubation using ultrasound examination and radiological imaging, to verify positioning. Results were analyzed in terms of diagnostic accuracy. RESULTS The tubes were correctly positioned in 157 cases (98.7%), according to radiological images, and in 156 cases (98.1%), according to ultrasound. The sensitivity analysis was 0.98 and the positive predictive value was 0.99. It was not possible to perform a specificity analysis, as there were not enough negative cases in the sample. IMPLICATIONS FOR PRACTICE The use of ultrasonography to identify correct positioning of gastric tubes in infants and newborns shows good sensitivity. IMPLICATIONS FOR RESEARCH It was not possible to evaluate the ultrasonography specificity; further studies with greater samples are probably necessary, so that this objective can be achieved.Video Abstract available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?videoId=29&autoPlay=true.
-
3.
Ultrasonographic evaluation of gastric contents in term pregnant women fasted for six hours.
Hakak, S, McCaul, CL, Crowley, L
International journal of obstetric anesthesia. 2018;:15-20
Abstract
BACKGROUND Current fasting guidelines suggest six hours are adequate to minimise the aspiration risk after a light meal consumed by pregnant women undergoing elective caesarean section. We assessed gastric contents in non-labouring pregnant women, using ultrasonographic analysis. METHODS In a prospective study, pregnant women ≥36 weeks' gestation, without conditions likely to influence gastric emptying, underwent ultrasonographic analysis of their gastric antrum, after six hours of fasting following a standardised light meal. The primary outcome was solid food content in the antrum. Other outcomes included fluid in the supine and right lateral positions, antral cross-sectional area and estimated residual gastric fluid volume. Antral grades were classified: grade 0 = absence of fluid in both supine and right lateral positions: grade 1 = fluid present in the right lateral position only: grade 2 = fluid in both positions. RESULTS Complete data were available in 46/51 (90%) women. No woman had solid food visible. Antral grades 0, 1 and 2 were seen in 6 (13%), 36 (78%) and 4 (9%) women respectively. Eighteen of 48 women (37.5%) had a residual volume greater than 1.5 mL/kg. Of those with a grade 1 antrum, 13/36 (36%) had residual volumes in excess of 1.5 mL/kg. For grade 2, this was 4/4 (100%). CONCLUSIONS Our cohort of pregnant women fasted for six hours had no solid food visible in the antrum, but many had both qualitative and quantitative ultrasonographic evidence of gastric volumes potentially associated with aspiration risk. This suggests that pregnancy-specific fasting guidelines may be required.
-
4.
Routine gastric residual volume measurement and energy target achievement in the PICU: a comparison study.
Tume, LN, Bickerdike, A, Latten, L, Davies, S, Lefèvre, MH, Nicolas, GW, Valla, FV
European journal of pediatrics. 2017;(12):1637-1644
-
-
Free full text
-
Abstract
UNLABELLED Critically ill children frequently fail to achieve adequate energy intake, and some care practices, such as the measurement of gastric residual volume (GRV), may contribute to this problem. We compared outcomes in two similar European Paediatric Intensive Care Units (PICUs): one which routinely measures GRV (PICU-GRV) to one unit that does not (PICU-noGRV). An observational pilot comparison study was undertaken. Eighty-seven children were included in the study, 42 (PICU-GRV) and 45 (PICU-noGRV). There were no significant differences in the percentage of energy targets achieved in the first 4 days of PICU admission although PICU-noGRV showed more consistent delivery of median (and IQR) energy targets and less under and over feeding for PICU-GRV and PICU-noGRV: day 1 37 (14-72) vs 44 (0-100), day 2 97 (53-126) vs 100 (100-100), day 3 84 (45-112) vs 100 (100-100) and day 4 101 (63-124) vs 100 (100-100). The incidence of vomiting was higher in PICU-GRV. No necrotising enterocolitis was confirmed in either unit, and ventilator-acquired pneumonia rates were not significantly different (7.01 vs 12 5.31 per 1000 ventilator days; p = 0.70) between PICU-GRV and PICU-noGRV units. CONCLUSIONS The practice of routine gastric residual measurement did not significantly impair energy targets in the first 4 days of PICU admission. However, not measuring GRV did not increase vomiting, ventilator-acquired pneumonia or necrotising enterocolitis, which is the main reason clinicians cite for measuring GRV. What is known: • The practice of routinely measuring gastric residual volume is widespread in critical care units • This practice is increasingly being questioned in critically ill patients, both as a practice that increases • The likelihood of delivering inadequate enteral nutrition amounts and as a tool to assess feeding tolerance What is new: • Not routinely measuring gastric residual volume did not increase adverse events of ventilator acquired pneumonia, necrotising enterocolitis or vomiting. • In the first 4 days of PICU stay, energy target achievement was not significantly different, but the rates of under and over feeding were higher in the routine GRV measurement unit.
-
5.
Ultrasound assessment of gastric contents in children undergoing elective ear, nose and throat surgery: a prospective cohort study.
Desgranges, FP, Gagey Riegel, AC, Aubergy, C, de Queiroz Siqueira, M, Chassard, D, Bouvet, L
Anaesthesia. 2017;(11):1351-1356
-
-
Free full text
-
Abstract
Ultrasound examination of the gastric antrum allows reliable assessment of gastric contents and volume. Postoperative assessment of gastric contents before recovery from anaesthesia could help the physician to choose the most appropriate extubation technique after surgery in children. In this prospective observational study, we assessed whether significant changes occurred in gastric contents during the intra-operative period in children undergoing elective ear, nose and throat (ENT) surgery. Children aged between six months and 16 years were recruited consecutively. Ultrasound examination of the antrum was performed before induction of anaesthesia and at the end of surgery before tracheal extubation, and included quantitative and qualitative assessment of gastric contents. The mean (SD) gastric volume was 0.28 (0.30) ml.kg-1 before surgery and 0.27 (0.30) ml.kg-1 after surgery, p = 0.82. No solid contents were identified in the antrum, and the gastric volume was < 1.5 ml.kg-1 in all patients during both ultrasound examinations. Our results suggest that, after elective ENT surgery, children are not at risk of a full stomach before tracheal extubation, and that pulmonary aspiration of blood that may occur after elective ENT surgery is probably not related to regurgitation of ingested blood from the stomach.
-
6.
Incomplete type of intestinal metaplasia has the highest risk to progress to gastric cancer: results of the Spanish follow-up multicenter study.
González, CA, Sanz-Anquela, JM, Companioni, O, Bonet, C, Berdasco, M, López, C, Mendoza, J, Martín-Arranz, MD, Rey, E, Poves, E, et al
Journal of gastroenterology and hepatology. 2016;(5):953-8
Abstract
BACKGROUND AND AIM In high or moderate risk populations, periodic surveillance of patients at risk of progression from gastric precursor lesions (PL) to gastric cancer (GC) is the most effective strategy for reducing the burden of GC. Incomplete type of intestinal metaplasia (IIM) may be considered as the best candidate, but it is still controversial and more research is needed. To further assess the progression of subtypes of IM as predictors of GC occurrence. METHODS A follow-up study was carried-out including 649 patients, diagnosed with PL between 1995-2004 in 9 participating hospitals from Spain, and who repeated the biopsy during 2011-2013. Medical information and habits were collected through a questionnaire. Based on morphology, IM was sub-classified as complete (small intestinal type, CIM) and incomplete (colonic type, IIM). Analyses were done using Cox (HR) models. RESULTS At baseline, 24% of patients had atrophic gastritis, 38% CIM, 34% IIM, and 4% dysplasia. Mean follow-up was 12 years. 24 patients (3.7%) developed a gastric adenocarcinoma during follow-up. The incidence rate of GC was 2.76 and 5.76 per 1,000 person-years for those with CIM and IIM, respectively. The HR of progression to CG was 2.75 (95% CI 1.06-6.26) for those with IIM compared with those with CIM at baseline, after adjusting for sex, age, smoking, family history of GC and use of NSAIDs. CONCLUSIONS IIM is the PL with highest risk to progress to GC. Sub-typing of IM is a valid procedure for the identification of high risk patients that require more intensive surveillance.
-
7.
abiliti Closed-Loop Gastric Electrical Stimulation System for Treatment of Obesity: Clinical Results with a 27-Month Follow-Up.
Horbach, T, Thalheimer, A, Seyfried, F, Eschenbacher, F, Schuhmann, P, Meyer, G
Obesity surgery. 2015;(10):1779-87
-
-
Free full text
-
Abstract
BACKGROUND The aim of the study was to evaluate the safety and effectiveness of a novel closed-loop gastric electric stimulation device (abiliti system) featuring a transgastric sensor to detect food intake and an accelerometer to record physical activity to induce and maintain lifestyle changes to treat obesity. METHODS In a prospective, multi-center study, 34 obese subjects (BMI of 42.1 ± 5.3 kg/m(2)) who passed an eligibility evaluation were implanted with the abiliti system. Safety evaluation included an endoscopic exam to assess the intragastric electrode healing. Efficacy evaluation at 1 year of therapy included weight loss, improvements in eating, and exercise behavior and quality of life. RESULTS The transgastric implant controlled by endoscopy was stable for all participants. At 12 months (12 M) the mean excess weight loss (EWL) was 28.7% (95%CI, 34.5 to 22.5%), and mean reduction in BMI was 4.8 ± 3.2 kg/m(2). At 27 months (27 M), the EWL was 27.5% (95% CI, 21.3% to 33.7%). Eating behavior, evaluated by the "Three Factor Eating Questionnaire", showed a significant increase in the cognition factor and decrease in the disinhibition and hunger factors at 12 M in comparison to baseline (p < 0.001). Participants significantly increased their weekly physical activity (p < 0.001). Quality of life was improved in 55.2% of the patients. CONCLUSIONS Gastric electrical stimulation with abiliti system in obese participants is well tolerated and leads to significant 12 M weight loss, which was stable to 27 M. We suggest that weight loss is achieved due to the assessed alteration of eating behavior in particular the reduction in disinhibition and hunger, and the measured increase in physical activity.
-
8.
Interrater reliability of qualitative ultrasound assessment of gastric content in the third trimester of pregnancy.
Arzola, C, Cubillos, J, Perlas, A, Downey, K, Carvalho, JC
British journal of anaesthesia. 2014;(6):1018-23
-
-
Free full text
-
Abstract
BACKGROUND Pulmonary aspiration of gastric contents in pregnant women undergoing general anaesthesia is one of the most feared complications in obstetric anaesthesia. Bedside gastric ultrasonography is a feasible imaging tool to assess the gastric content. The purpose of this study was to investigate the reliability of qualitative bedside assessment of the gastric content performed by anaesthesiologists on third trimester pregnant women. METHODS Pregnant women (≥32 weeks gestational age) were randomized to undergo ultrasound (US) assessments of their stomach in a fasting state (>8 h), or after ingestion of clear fluids only, or solid food. Three anaesthesiologists trained in gastric ultrasonography performed the assessments using a low-frequency curved-array US transducer (5-2 MHz). Primary outcome of the study was the consistency of raters in diagnosing the correct status of the gastric content, which was used to determine the interrater reliability among the three anaesthesiologists. Secondary outcomes were overall proportion of correct and incorrect diagnoses and the specific proportions of correct diagnosis across the three gastric content groups. RESULTS We analysed 32 pregnant women. The interrater reliability displayed a kappa statistic of 0.74 (bias corrected 95% CI: 0.68-0.84). The overall proportion of correct diagnosis was 87.5% (84 of 96). The odds of correct diagnosis for 'solid contents' were 16.7 times the odds for 'empty', and 14.3 times for 'clear fluid'. CONCLUSIONS Our results show the consistency of the qualitative US assessment of gastric contents of pregnant women in the third trimester by anaesthesiologists. A kappa of 0.74 suggests substantial agreement in terms of interrater reliability for this diagnostic measurement. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01564030.