Department of Emergency Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, 249203, Uttarakhand, India.
Department of Trauma and Emergency, All India Institute of Medical Sciences Raipur, Raipur, India.
BMC Emerg Med. 2023 Sep 21;23(1):111. doi: 10.1186/s12873-023-00881-z.
One significant cause of morbidity and mortality in patients undergoing endotracheal intubation is the aspiration of gastric contents. Its prevalence is more in the emergency than in elective settings. Point-of-care gastric ultrasound (GUS) is a non-invasive bedside ultrasonogram that provides both qualitative and quantitative information about the stomach contents. The diagnostic accuracy of GUS in terms of gastric parameters (measured antral diameters, antral cross-sectional area, and calculated gastric volume) to predict aspiration is yet unknown. We aim to determine this in the patients undergoing urgent emergency intubation (UEI) in the emergency department.
A prospective observational study was conducted at the emergency department of a tertiary healthcare center in India. Patients requiring UEI were identified and a bedside gastric ultrasound was done in the right lateral decubitus position using low frequency curved array probe. The qualitative data and the antral diameters (anteroposterior and craniocaudal) were assessed. The patient's clinical parameters and history regarding the last meal were noted. The cross-sectional area of gastric antrum was calculated using CSA = (AP × CC) π/4. The gastric volume is estimated using Perla's formula: GV = 27.0 + 14.6(RLD CSA) -1.28(age).
A hundred patients requiring urgent endotracheal intubation were enrolled in the study. Visible aspiration was more in participants with a distended gastric status (χ2 = 16.880, p = < 0.001). The median gastric volume in the patients who aspirated was 146.37 mL, and it ranged from 111.59 mL-201.01 mL. Using ROC analysis, a cut-off of CC diameter ≥ 2.35 cm (sensitivity 88%, specificity 91%) and AP diameter ≥ 5.15 cm (sensitivity 88%, specificity 87%) predicts aspiration. A calculated USG CSA cut-off ≥ 9.27cm (sensitivity 100%, specificity 87%) and an USG gastric volume ≥ 111.594 mL (sensitivity 100%, a specificity 92%) predicts aspiration.
Point-of-care gastric ultrasound is an useful non-invasive bedside tool for risk stratification for aspiration in busy emergency rooms. We present threshold gastric antral parameters that can be used to predict aspiration along with its diagnostic accuracy. This can help the treating ED physician take adequate precautions, decide on intubation techniques and treatment modifications to aid in better patient management.
在接受气管插管的患者中，胃内容物吸入是发病率和死亡率的一个重要原因。在紧急情况下比在择期情况下更为常见。即时床旁超声（GUS）是一种非侵入性的床边超声检查，可提供胃内容物的定性和定量信息。GUS 预测胃参数（测量的胃窦直径、胃窦横截面积和计算的胃容量）方面的诊断准确性尚不清楚。我们旨在确定印度一家三级医疗中心急诊科接受紧急紧急插管（UEI）的患者中的这一点。
在印度一家三级医疗中心的急诊科进行了一项前瞻性观察研究。确定需要 UEI 的患者，并使用低频曲面阵列探头在右侧侧卧位进行床边胃超声检查。评估定性数据和胃窦直径（前后和头足）。记录患者的临床参数和有关最后一餐的病史。使用 CSA =（AP × CC）π/4 计算胃窦横截面积。使用 Perla 公式估计胃容量：GV = 27.0 + 14.6（RLD CSA）-1.28（年龄）。
本研究共纳入 100 名需要紧急气管插管的患者。胃扩张状态的参与者中可见更多的吸入（χ2 = 16.880，p < 0.001）。吸入患者的中位胃容量为 146.37 毫升，范围为 111.59 毫升至 201.01 毫升。使用 ROC 分析，CC 直径≥2.35 厘米（敏感性 88%，特异性 91%）和 AP 直径≥5.15 厘米（敏感性 88%，特异性 87%）的截断值可预测吸入。计算出的 USG CSA 截断值≥9.27cm（敏感性 100%，特异性 87%）和 USG 胃容量≥111.594ml（敏感性 100%，特异性 92%）可预测吸入。
即时床旁超声是一种有用的非侵入性床边工具，可用于对繁忙的急诊科中发生吸入的风险进行分层。我们提出了可以用于预测吸入的临界胃窦参数及其诊断准确性。这可以帮助治疗 ED 医生采取适当的预防措施，决定插管技术和治疗修改，以帮助更好地管理患者。
