359 - Point-of-Care Ultrasound Comparison of Nil-Per-Os Gastric Volumes in the Pediatric ED

Poster Number: 359
Publication Number: 359.205

Matthias M. Manuel, University of Texas Southwestern Medical School, Dallas, TX, United States; Kenneth Yen, University of Texas Southwestern Medical School, Dallas, TX, United States; Jiwoong J. Shin, University of Texas Southwestern Medical School, Dallas, TX, United States; Steven M. Field, University of Texas Southwestern Medical School, Dallas, TX, United States; Michael C. Cooper, University of Texas Southwestern Medical School, Dallas, TX, United States

Background: Fasting requirement for procedural sedation continues to affect pediatric-ED (PED) throughput as the debate about its relevance continues. Point-of-care ultrasound (POCUS) of gastric content and volume may provide useful real-time data to determine optimal time and readiness of patients for procedural sedation.

Objective: The objective of this study was to compare gastric volume (GV) at the 2- and 4-hour NPO time points. Secondarily we compared the 2- and 4-hour GVs to the recommended at-risk volume of 0.4ml/Kg for solids. We hypothesized no difference in GV at the 2- and 4-hour patient-reported NPO time points.

Design/Methods: A one-year prospective pilot study of previously healthy patients aged 3-18 years who reported having a solid meal 2 to 4 hours prior to visiting the PED of a tertiary care children’s hospital with conditions for which procedural sedation was anticipated. POCUS estimating gastric antral cross-sectional area (CSA) in supine and right-lateral-decubitus (RLD) positions were performed by a single POCUS credentialed provider at the 2- and 4-hour NPO time points. We performed appropriate descriptive, t-test, and generalized linear model (GLM) analyses to compare variance in gastric volume (estimated by the validated formula: GV (ml) = -7.8 + [3.5*CSA] + [0.127*Age in months]) using SAS 9.4®

Results: Of 352 patients screened, 100 were enrolled. Mean age was 10.2 years and 70.0% were males. There was no statistically significant difference in age (p=0.304), race (p=0.869), ethnicity (p=0.768), BMI percentile (p=0.439), or estimated GVs (p=0.458) between the 2- and 4-hour NPO groups in univariate modeling. Similarly, in a multivariable model adjusted for age, gender, BMI, and possible interactions between predictors, there was no statistically significant difference in estimated GV at the 2- and 4-hour NPO time points (p=0.276). However, GV at the 2- and 4-hour NPO time points were significantly greater than the suggested at-risk GV for solids (p < .0001).Conclusion(s): Despite the limitations of this study, the results show that estimated GV at the 2- and 4-hour NPO time points are not significantly different. While the debate about pre-sedation fasting requirement for ED procedures continues, there may be benefit in decreasing fasting requirement for solids to 2-hours.
CV_Matthias.ManuelMatthias_Manuel_ CV.1.5.2022.pdf