Ruiz Ávila Héctor Andrés, Espinosa Almanza Carmelo José, Fuentes Barreiro Cindy Yohana
Anestesiologo-Intensivista, Unidad de Cuidados Intensivos, Hospital Universitario Nacional de Colombia, Bogotá, D.C, Colombia.
Docente Asociado Universidad Militar Nueva Granada, Bogotá, D.C, Colombia.
Ultrasound J. 2023 Mar 19;15(1):14. doi: 10.1186/s13089-023-00312-x.
The assessment of gastric content and volume using bedside ultrasound (US) has become a useful tool in emergency departments, anesthesiology departments and inpatient wards, as it provides a rapid and dynamic assessment of the gastric content of patients, which, allows making decisions regarding the risk of regurgitation or the need to adjust the strategy used to induce general anesthesia in patients with a full stomach. This assessment consists of two evaluations: a qualitative one, in which the status of the antrum, in terms of gastric content, is classified into three categories (empty, liquid content and full), and a quantitative one, where gastric volume is estimated. The objective of this study was to estimate the intra-observer and inter-observer agreement in ultrasound assessment of gastric content and volume in critically ill patients receiving enteral nutrition.
A total of 41 patients were included and each examiner performed 64 gastric US (n = 128). Participants' average age was 56.5 years (SD ± 12.6) and 63.4% were men. Regarding the qualitative evaluation of the antrum, in supine position both examiners classified the gastric content as grade 0 in 1 gastric US (1.5%), grade 1 in 4 gastric US (6.2%) and grade 2 in 59 (92.1%). Regarding intra-observer variability in the measurement of the area of the antrum, Lin's concordance correlation coefficient (CCC), the difference of means between measurements and the 95% limits of agreement of Bland and Altman values were 0.95 (95% CI 0.940-0.977), - 0.47 cm (SD ± 1.64) and - 3.70 cm to 2.75 cm, respectively, in EC1, and 0.94 (95% CI 0.922-0.973), - 0.18 cm (SD ± 2.18) and - 4.47 cm to 4.09 cm in EC2. Concerning to inter-observer variability (EC1 vs EC2) in the measurement of the area of the antrum and of gastric volume, the following CCC, mean difference between measurements and 95% limits of agreement of Bland and Altman values were obtained: measurement of the area of the antrum: 0.84 (95% CI 0.778-0.911), - 0.86 cm (SD ± 3.38) and - 7.50 cm to 5.78 cm; gastric volume measurement: 0.84 (95% CI 0.782-0.913), - 12.3 mL (SD ± 49.2) and - 108.8 mL to 84.0 mL.
The assessment of gastric content and volume using bedside US in critically ill patients on mechanical ventilation and receiving enteral nutrition showed a good intra and inter-rater reliability. Most of the patients included in the study had a high risk of pulmonary aspiration, since, according to the results of the gastric US evaluation, they had gastric volumes > 1.5 mL/kg.
使用床旁超声（US）评估胃内容物和容量已成为急诊科、麻醉科和住院病房的一项有用工具，因为它能对患者的胃内容物进行快速动态评估，从而有助于就反流风险或调整饱胃患者全身麻醉诱导策略的必要性做出决策。该评估包括两项评价：定性评价，即根据胃内容物情况将胃窦状态分为三类（空胃、有液体内容物、充满）；定量评价，即估计胃容量。本研究的目的是评估接受肠内营养的危重症患者胃内容物和容量超声评估中的观察者内和观察者间一致性。
共纳入41例患者，每位检查者进行64次胃超声检查（n = 128）。参与者的平均年龄为56.5岁（标准差±12.6），63.4%为男性。关于胃窦的定性评估，在仰卧位时，两位检查者在1次胃超声检查（1.5%）中将胃内容物分类为0级，在4次胃超声检查（6.2%）中分类为1级，在59次（92.1%）中分类为2级。关于胃窦面积测量的观察者内变异性，在检查者1（EC1）中，林氏一致性相关系数（CCC）、测量均值之差以及布兰德-奥特曼值的95%一致性界限分别为0.95（95%置信区间0.940 - 0.977）、-0.47 cm（标准差±1.64）和-3.70 cm至2.75 cm；在检查者2（EC2）中分别为0.94（95%置信区间0.922 - 0.973）、-0.18 cm（标准差±2.18）和-4.47 cm至4.09 cm。关于胃窦面积和胃容量测量的观察者间变异性（EC1与EC2），获得了以下CCC、测量均值之差以及布兰德-奥特曼值的95%一致性界限：胃窦面积测量：0.84（95%置信区间0.778 - 0.911）、-0.86 cm（标准差±3.38）和-7.50 cm至5.78 cm；胃容量测量：0.84（95%置信区间）0.782 - 0.913）、-12.3 mL（标准差±49.2）和-108.8 mL至84.0 mL。
在接受机械通气并接受肠内营养的危重症患者中，使用床旁超声评估胃内容物和容量显示出良好的观察者内和观察者间可靠性。根据胃超声评估结果，本研究中纳入的大多数患者有较高的肺误吸风险，因为他们的胃容量>1.5 mL/kg。
