Routine point-of-care ultrasound (POCUS) assessment of gastric antral content in traumatic emergency surgical patients for prevention of aspiration pneumonitis: an observational clinical trial

BACKGROUND: Polytrauma patients are at a higher risk of delayed gastric emptying. To assess the gastric volume, a reliable diagnostic tool is needed to prevent the occurrence of aspiration pneumonia, which remains a serious complication associated with anesthesia. Gastric antral ultrasound can provide reliable information about the size of the gastric antrum in traumatized patients undergoing emergency surgery. METHODS: A prospective observational study of 45 polytrauma patients undergoing emergency surgery under general anesthesia was carried out. Prior to induction of anesthesia in the emergency department, gastric ultrasound was performed for qualitative and quantitative assessment of the gastric antrum in a supine position and right lateral decubitus (RLD) position. This was followed by routine placement of the nasogastric tube to aspirate and calculate the volume of the stomach contents. RESULTS: Of the 45 polytrauma patients, the risk assessment of aspiration and the anesthesia technique changed in 14 patients (31.1%) after the gastric ultrasound examination. A very good relationship existed between the expected stomach volume at the RLD position and the suction volume in the nasogastric tube. In all cases, no aspirations were documented. CONCLUSION: Ultrasound examination of the stomach in polytrauma patients allows assessing the size and type of stomach contents. The data obtained can influence the choice of anesthesia technique and reduce the risk of aspiration pneumonia. TRIAL REGISTRATION: This trial was registered at ClinicalTrials.gov. registry number: NCT04083677 on September 6, 2019.