Fasting does not guarantee empty stomach in the intensive care unit: A prospective ultrasonographic evaluation (The NUTRIGUS study) - 17/12/21
, Anne Drihem a, Viven Berthoud a, Ophélie Dransart-Raye a, Loic Bartamian a, Isabelle Gounot a, Pierre-Grégoire Guinot a, b, c, d, Belaid Bouhemad a, b, c, dBienvenue sur EM-consulte, la référence des professionnels de santé.
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| pages | 6 |
| Iconographies | 3 |
| Vidéos | 0 |
| Autres | 0 |
Highlights |
• | The incidence of full stomach was high in intensive care patients. |
• | Fasting characteristics were unrelated to gastric emptying. |
• | Gastric ultrasound might be useful to tailor fasting prior extubation. |
Abstract |
Background |
In the intensive care unit (ICU), a fasting period is usually respected to avoid gastric aspiration during airway management procedures. Since there are no recognised guidelines, intensive care physicians balance the aspiration risk with the negative consequences of underfeeding. Our objective was to determine the impact of fasting on gastric emptying in critically ill patients by using gastric ultrasound.
Material and methods |
Among the 112 patients that met the inclusion criteria, 100 patients were analysed. Gastric ultrasonography was performed immediately before extubation. Patients with either 1/ an absence of visualised gastric content (qualitative evaluation) or 2/ a gastric volume < 1.5 mll/kg in case of clear fluid gastric content (quantitative evaluation) were classified as having an empty stomach.
Main findings |
In our study, twenty-six (26%) patients had a full stomach at the time of extubation. The incidence of full stomach was not significantly different between patients who fasted < 6 h or patients who fasted ≥ 6 h. Among the 57 patients receiving enteral nutrition (EN) within the last 48 h, there was no correlation between the duration of EN interruption and the GAA. The absence of EN was not associated with an empty stomach.
Conclusion |
At the time of extubation, the incidence of full stomach was high and not associated with the fasting characteristics (duration/absence of EN). Our results support the notions that fasting before airway management procedures is not a universal paradigm and that gastric ultrasound might represent a useful tool in the tailoring process.
ClinicalTrials.gov |
NCT04245878
Le texte complet de cet article est disponible en PDF.Abbreviations : CSA, EN, GAA, ICU
Keywords : Gastric ultrasound, Critical care, Point-of-care-ultrasound, Fasting, Gastric antral area, Empty stomach, Airway management
Plan
Vol 40 - N° 6
Article 100975- décembre 2021 Retour au numéro
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