Department of Anaesthesiology and Intensive Care, Pierre Paul Riquet Hospital, University Hospital of Toulouse, University Toulouse-3 Paul Sabatier, 31059 Toulouse, France.
Department of Anaesthesiology and Intensive Care, Pierre Paul Riquet Hospital, University Hospital of Toulouse, University Toulouse-3 Paul Sabatier, 31059 Toulouse, France.
Anaesth Crit Care Pain Med. 2021 Jun;40(3):100836. doi: 10.1016/j.accpm.2021.100836. Epub 2021 Mar 19.
In urgent situations, preoperative full stomach assessment mostly relies on clinical judgment. Our primary objective was to assess the diagnostic performance of clinical judgment for the preoperative assessment of full stomach in urgent patients compared to gastric point-of-care ultrasound (PoCUS). Our secondary objective was to identify risk factors associated with PoCUS full stomach in urgent patients.
We led a prospective observational study at our Hospital, between January and July 2016. Adult patients admitted for urgent surgery were eligible. Patients with altered gastric sonoanatomy, interventions reducing stomach content, impossible lateral decubitus were excluded. Clinical judgment and risk factors of full stomach were collected before gastric PoCUS measurements. Ultrasonographic full stomach was defined by solid contents or liquid volume ≥ 1.5 ml kg. Diagnostic performance was assessed through sensitivity, specificity, accuracy, positive and negative predictive value.
The prevalence of clinical and PoCUS full stomach in 196 included patients was 29% and 27%, respectively. Positive and negative predictive values were 42% (95% CI: 32.3-52.6%) and 79% (95% CI: 74.9-83.4%), respectively. Patients with PoCUS full stomach were clinically misdiagnosed in 55% of cases. PoCUS full stomach was associated with abdominal or gynaecological-obstetrical surgery (OR 3.6, 95% CI: 1.5-8.8, P < 0.01) but not with fasting durations. Positive solid intake after illness onset with respect to 6-h solid fasting rule was associated with PoCUS low-risk gastric content (OR 0.4, 95% CI: 0.2-0.9, P = 0.03).
Clinical judgment showed poor-to-moderate performance in urgent surgical patients for the diagnosis of full stomach. Gastric PoCUS should be used to assess risk of full stomach in this population.
在紧急情况下，术前饱腹评估主要依赖于临床判断。我们的主要目标是评估临床判断与胃即时超声检查（PoCUS）相比，在紧急患者术前评估饱腹方面的诊断性能。我们的次要目标是确定与紧急患者胃 PoCUS 全胃相关的危险因素。
我们在 2016 年 1 月至 7 月期间在我们的医院进行了一项前瞻性观察研究。符合条件的是因紧急手术而入院的成年患者。排除胃超声检查异常、减少胃内容物的干预措施、无法侧卧的患者。在胃 PoCUS 测量前收集临床判断和全胃的危险因素。超声全胃定义为固体内容物或液体量≥1.5ml/kg。通过灵敏度、特异性、准确性、阳性和阴性预测值评估诊断性能。
196 例患者中，临床和 PoCUS 全胃的患病率分别为 29%和 27%。阳性和阴性预测值分别为 42%（95%CI：32.3-52.6%）和 79%（95%CI：74.9-83.4%）。PoCUS 全胃患者在 55%的情况下被临床误诊。PoCUS 全胃与腹部或妇科-产科手术相关（OR 3.6，95%CI：1.5-8.8，P<0.01），但与禁食时间无关。发病后阳性固体摄入与 6 小时固体禁食规则相比，与 PoCUS 低风险胃内容物相关（OR 0.4，95%CI：0.2-0.9，P=0.03）。
在紧急外科患者中，临床判断在诊断全胃方面表现出差到中等的性能。在该人群中，应使用胃 PoCUS 评估全胃风险。
