Gastric ultrasound as a point of care tool

Abstract

Sir, We sincerely thank Dr. Van De Putte et al. for their letter. Our study was done between 1st June 2016 and 1st March 2017. Our primary objective was to see whether point of care gastric ultrasound (GUS) can help us identify the gastric contents and gastric volume and secondary objective was to correlate the gastric content and gastric volumes with fasting times and in patients with comorbidities. During the course of our study we scanned 100 patients coming for elective surgeries. In order to reflect the kind of cases seen in a large tertiary hospital in India, we chose the subjects randomly irrespective of their comorbidities. And, it turned out that there were only 20 patients with no comorbidities. Rest of them had one or the other comorbidities which can affect gastric emptying. Apart from the comorbidities a number of factors could affect the residual gastric volume: age, pain, stress/anxiety, altered sleep pattern, altered meal times, type of food consumed before starting to fast, alcohol intake, smoking, and sleeping posture.[123] All these individually or in combination might offer an explanation to the difference in the incidences. We thank the authors for bringing the clarity on use of the mathematical model. The model is validated for scanning measurements taken in right lateral decubitus position only. We scanned the patients first in supine position followed by right lateral position. The readings taken in the right lateral position were considered as final and the same have been used in results. The study team have been using bedside USG for more than 13 years. Since it was the first study on GUS coming from India, authors have taken the help of radiology team to improve the accuracy. We have given details of the comorbidities and the duration of fasting of the patients we have studied. The difference compared to previously published results could possibly be due to increased number of patients with comorbidities (80% in our study), duration of fasting (average fasting duration: 10 hours). On top of this there might be other contributing factors like ethnic Indian community, Indian food the night before and others mentioned earlier. After subgroup analysis we found diabetes mellitus, obesity, and chronic kidney disease (CKD)[4] had an influence on the residual gastric volume and contents. In our study, there were four patients with CKD, who had come for arteriovenous fistula formation. All of them had a statistically significant increase in the cross-sectional area and gastric volume compared to patients with comorbidities. As stated in the article further evaluation with an appropriately powered study will need to be done before we can conclusively prove that patients with CKD have gastroparesis and make a recommendation for this subgroup. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

The authors' abstract, as published at the source. Indian Journal of Anaesthesia, 2019 · DOI ↗