Skip to main content

Advertisement

SpringerLink
Log in

Ultrasound assessment of gastric volume in critically ill patients

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Purpose

To assess the feasibility and validity of ultrasonographic measurement of gastric antral cross-sectional area (usCSA) in critically ill patients to predict gastric volume and the use of computed tomography (CT) as a reference to measure gastric volume.

Method

This single-center, prospective, cross-sectional study included 55 critically ill patients who had an abdominal CT scan. usCSA measurements were performed within the hour preceding the CT scan. Gastric volumes were measured on the CT scan using semiautomatic software. The feasibility rate, performing conditions (% “good” and “poor”), internal and external validity of antral usCSA measurements, performed by an ICU physician, were assessed to predict gastric volume.

Results

Antral usCSA measurements were feasible in 95 % of cases and were positively correlated with gastric volume measured by the CT scan when performed in “good” conditions (65 %) (r = 0.43). There was good reproducibility of measurements (intraclass correlation coefficient of 0.97, CI 95 % 0.96–0.99) and there was clinically acceptable agreement between measurements performed by radiologists and intensivists (bias −0.12 cm2). The receiver operating characteristic curve identified a cutoff value of 3.6 cm2 that discriminated an “at-risk stomach” (volume >0.8 mL/kg) at a sensitivity of 76 % and a specificity of 78 %.

Conclusions

Ultrasonographic measurement of antral CSA is feasible and reliable in the majority of critically ill patients. This technique could be useful to manage critically ill patients at risk of aspiration or with enteral feeding.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Marik PE (2001) Aspiration pneumonitis and aspiration pneumonia. N Engl J Med 344:665–671. doi:10.1056/NEJM200103013440908

    Article  CAS  PubMed  Google Scholar 

  2. Raidoo DM, Rocke DA, Brock-Utne JG et al (1990) Critical volume for pulmonary acid aspiration: reappraisal in a primate model. Br J Anaesth 65:248–250

    Article  CAS  PubMed  Google Scholar 

  3. (1999) Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologist Task Force on Preoperative Fasting. Anesthesiology 90:896–905

  4. Hsu C-W, Sun S-F, Lee DL et al (2011) Impact of disease severity on gastric residual volume in critical patients. World J Gastroenterol 17:2007–2012. doi:10.3748/wjg.v17.i15.2007

    Article  PubMed Central  PubMed  Google Scholar 

  5. Nguyen NQ, Ng MP, Chapman M et al (2007) The impact of admission diagnosis on gastric emptying in critically ill patients. Crit Care 11:R16. doi:10.1186/cc5685

    Article  PubMed Central  PubMed  Google Scholar 

  6. Nimmo WS, Heading RC, Wilson J et al (1975) Inhibition of gastric emptying and drug absorption by narcotic analgesics. Br J Clin Pharmacol 2:509–513

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Steyn PF, Twedt D, Toombs W (1997) The effect of intravenous diazepam on solid phase gastric emptying in normal cats. Vet Radiol Ultrasound Off 38:469–473

    Article  CAS  PubMed  Google Scholar 

  8. Mutlu GM, Mutlu EA, Factor P (2001) GI complications in patients receiving mechanical ventilation. Chest 119:1222–1241

    Article  CAS  PubMed  Google Scholar 

  9. Perlas A, Chan VWS, Lupu CM et al (2009) Ultrasound assessment of gastric content and volume. Anesthesiology 111:82–89. doi:10.1097/ALN.0b013e3181a97250

    Article  PubMed  Google Scholar 

  10. Bouvet L, Miquel A, Chassard D et al (2009) Could a single standardized ultrasonographic measurement of antral area be of interest for assessing gastric contents? A preliminary report. Eur J Anaesthesiol 26:1015–1019. doi:10.1097/EJA.0b013e32833161fd

    Article  PubMed  Google Scholar 

  11. Bouvet L, Mazoit J-X, Chassard D et al (2011) Clinical assessment of the ultrasonographic measurement of antral area for estimating preoperative gastric content and volume. Anesthesiology 114:1086–1092. doi:10.1097/ALN.0b013e31820dee48

    Article  PubMed  Google Scholar 

  12. Chapman MJ, Nguyen NQ, Fraser RJL (2007) Gastrointestinal motility and prokinetics in the critically ill. Curr Opin Crit Care 13:187–194. doi:10.1097/MCC.0b013e3280523a88

    Article  PubMed  Google Scholar 

  13. Ko JP, Berman EJ, Kaur M et al (2012) Pulmonary nodules: growth rate assessment in patients by using serial CT and three-dimensional volumetry. Radiology 262:662–671. doi:10.1148/radiol.11100878

    Article  PubMed Central  PubMed  Google Scholar 

  14. Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963

    Article  PubMed  Google Scholar 

  15. Baker SP, O’Neill B, Haddon W Jr, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196

    Article  CAS  PubMed  Google Scholar 

  16. Carp H, Jayaram A, Stoll M (1992) Ultrasound examination of the stomach contents of parturients. Anesth Analg 74:683–687

    CAS  PubMed  Google Scholar 

  17. Koenig SJ, Lakticova V, Mayo PH (2011) Utility of ultrasonography for detection of gastric fluid during urgent endotracheal intubation. Intensive Care Med 37:627–631. doi:10.1007/s00134-010-2125-9

    Article  PubMed  Google Scholar 

  18. Podczeck F, Mitchell CL, Newton JM et al (2007) The gastric emptying of food as measured by gamma-scintigraphy and electrical impedance tomography (EIT) and its influence on the gastric emptying of tablets of different dimensions. J Pharm Pharmacol 59:1527–1536. doi:10.1211/jpp.59.11.0010

    Article  PubMed  Google Scholar 

  19. Willems M, Quartero AO, Numans ME (2001) How useful is paracetamol absorption as a marker of gastric emptying? A systematic literature study. Dig Dis Sci 46:2256–2262

    Article  CAS  PubMed  Google Scholar 

  20. Jordi J, Verrey F, Lutz TA (2013) Simultaneous assessment of gastric emptying and secretion in rats by a novel computed tomography based method. Am J Physiol Gastrointest Liver Physiol. doi:10.1152/ajpgi.00230.2013

    PubMed  Google Scholar 

  21. Jordi J, Herzog B, Camargo SMR et al (2013) Specific amino acids inhibit food intake via the area postrema or vagal afferents. J Physiol 591:5611–5621. doi:10.1113/jphysiol.2013.258947

    Article  CAS  PubMed  Google Scholar 

  22. Karcz WK, Kuesters S, Marjanovic G et al (2008) 3D-MSCT gastric pouch volumetry in bariatric surgery—preliminary clinical results. Obes Surg 19:508–516. doi:10.1007/s11695-008-9776-4

    Article  PubMed  Google Scholar 

  23. Wormanns D, Kohl G, Klotz E et al (2004) Volumetric measurements of pulmonary nodules at multi-row detector CT: in vivo reproducibility. Eur Radiol 14:86–92. doi:10.1007/s00330-003-2132-0

    Article  PubMed  Google Scholar 

  24. Bolte H, Riedel C, Jahnke T et al (2006) Reproducibility of computer-aided volumetry of artificial small pulmonary nodules in ex vivo porcine lungs. Invest Radiol 41:28–35

    Article  PubMed  Google Scholar 

  25. Yeguiayan J-M, Garrigue D, Binquet C et al (2011) Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study. Crit Care 15:R34. doi:10.1186/cc9982

    Article  PubMed Central  PubMed  Google Scholar 

  26. Metheny NA, Stewart J, Nuetzel G et al (2005) Effect of feeding-tube properties on residual volume measurements in tube-fed patients. JPEN J Parenter Enter Nutr 29:192–197

    Article  Google Scholar 

  27. Mayo PH (2013) Critical care ultrasonography: the Italian approach. Intensive Care Med 39:1849–1850. doi:10.1007/s00134-013-3011-z

    Article  PubMed  Google Scholar 

  28. Scalea TM, Rodriguez A, Chiu WC et al (1999) Focused assessment with sonography for trauma (FAST): results from an international consensus conference. J Trauma 46:466–472

    Article  CAS  PubMed  Google Scholar 

  29. Carrie C, Gisbert-Mora C, Quinart A et al (2012) Non-occlusive mesenteric ischemia detected by ultrasound. Intensive Care Med 38:333–334. doi:10.1007/s00134-011-2424-9

    Article  PubMed  Google Scholar 

  30. Moriwaki Y, Sugiyama M, Toyoda H et al (2009) Ultrasonography for the diagnosis of intraperitoneal free air in chest-abdominal-pelvic blunt trauma and critical acute abdominal pain. Arch Surg 144:137–141. doi:10.1001/archsurg.2008.553 discussion 142

    Article  PubMed  Google Scholar 

  31. Lamperti M, Bodenham AR, Pittiruti M et al (2012) International evidence-based recommendations on ultrasound-guided vascular access. Intensive Care Med 38:1105–1117. doi:10.1007/s00134-012-2597-x

    Article  PubMed  Google Scholar 

  32. Volpicelli G, Elbarbary M, Blaivas M et al (2012) International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 38:577–591. doi:10.1007/s00134-012-2513-4

    Article  PubMed  Google Scholar 

  33. Expert Round Table on Ultrasound in ICU (2011) International expert statement on training standards for critical care ultrasonography. Intensive Care Med 37:1077–1083. doi:10.1007/s00134-011-2246-9

    Article  Google Scholar 

Download references

Acknowledgments

The authors declare that the study has been approved by the appropriate ethics committee (Comité d’Evaluation de l’Ethique des projets pour la Recherche Biomédicale, Paris Nord, France N°10-060) and was therefore performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Specific national laws have also been observed.

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Critical Care and Anesthesiology Department, AP-HP, Hôpital Beaujon, 100 boulevard du général Leclerc, 92110, Clichy, France

    S. R. Hamada, C. Paugam-Burtz & J. Mantz

  2. Hôpitaux Universitaires Paris Nord Val de Seine, 75018, Paris, France

    S. R. Hamada, M. Ronot, C. Paugam-Burtz & J. Mantz

  3. Critical Care and Anesthesiology Department, AP-HP, Hôpital Bicêtre, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France

    S. R. Hamada

  4. Hôpitaux Universitaires Paris Sud, 94275, Le Kremlin Bicêtre, France

    S. R. Hamada

  5. University Pierre Marie Curie, 75013, Paris, France

    P. Garcon

  6. UR 10 UPMC, Paris VI, France

    P. Garcon

  7. Critical Care and Anesthesiology Department, AP-HP, Hôpital Pitie Salpétrière, 47-83 Boulevard de l’Hôpital, 75013, Paris, France

    P. Garcon

  8. Hôpitaux Universitaires Pitié Salpétrière, 75013, Paris, France

    P. Garcon

  9. University Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France

    M. Ronot, C. Paugam-Burtz & J. Mantz

  10. Radiology Department, AP-HP, Hôpital Beaujon, 100 boulevard du général Leclerc, 92110, Clichy, France

    M. Ronot

  11. ECSTRA Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Centre UMR, 1153, Inserm, Paris, France

    S. Kerever

  12. University Denis Diderot-Paris VII, Paris, France

    S. Kerever

Authors
  1. S. R. Hamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Garcon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Ronot
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Kerever
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Paugam-Burtz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Mantz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. R. Hamada.

Additional information

Take-home message: Gastric emptying is commonly disturbed in critically ill patients, and a simple, quick, reliable, and non-invasive bedside test to assess gastric volume would be of great interest. Ultrasound assessment of gastric cross-sectional area is feasible in critically ill patients and allows accurate discrimination of “at-risk stomachs”.

Electronic supplementary material

Below is the link to the electronic supplementary material.

134_2014_3320_MOESM1_ESM.doc

Electronic supplement 1: Correlation between US and CT measurements. usCSA ultrasonography of antral cross-sectional area, ctCSA computed tomography measurement of antral cross-sectional area, GV gastric volume measured on the CT scan. (DOC 37 kb)

134_2014_3320_MOESM2_ESM.tif

Electronic supplement 2. Bland–Altman diagram showing agreement between the radiologist and intensivists regarding the ultrasonographic measurements (n = 29). Results expressed in cm2. Mean = –0.12 cm2; mean + 2SD = 1.96 cm2; Mean – 2SD = –2.21 cm2. (TIFF 4563 kb)

134_2014_3320_MOESM3_ESM.tif

Electronic supplement 3. Receiver operating characteristic curve of antral cross-sectional area measured by ultrasound (usCSA) for a total gastric volume of ≥ 0.8 mL/kg. AUC area under the curve. (TIFF 4563 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hamada, S.R., Garcon, P., Ronot, M. et al. Ultrasound assessment of gastric volume in critically ill patients. Intensive Care Med 40, 965–972 (2014). https://doi.org/10.1007/s00134-014-3320-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-014-3320-x

Keywords

Search

Navigation