Utility of ultrasonography for detection of gastric fluid during urgent endotracheal intubation.

Abstract

Aspiration of gastric contents is a dangerous complication of urgent endotracheal intubation (UEI). Left upper quadrant (LUQ) ultrasonography may have the potential to decrease this complication by identifying patients with gastric fluid content, thereby allowing the UEI team to evacuate gastric contents prior to intubation. This was an observational study of 80 UEIs where LUQ ultrasonography was performed in a medical intensive care unit of a tertiary care hospital. The subjects were 80 patients requiring UEI. Gastric fluid content was identified as an anechoic or hypoechoic space in the appropriate anatomic position. If potentially consequential fluid was identified, it was evacuated using a gastric tube. Repeat LUQ ultrasonography confirmed removal of gastric contents prior to induction. A total of 80 patients had LUQ ultrasonography performed; 19 (24%) had gastric fluid content identified and 13 (16%) had sufficient gastric fluid content such that the UEI team proceeded with gastric tube insertion. Following gastric fluid removal, repeat ultrasonography showed absence of gastric fluid. Gastric fluid volume removed was 553 ± 290 ml (mean ± standard deviation, SD). None of the 80 patients had a clinically consequential aspiration event. Performance of ultrasonography took fewer than 2 min. No patient had complication related to the ultrasonography or removal of gastric contents. Ultrasonography is useful for the detection of gastric fluid. This technique may have utility in reducing risk of a clinically consequential aspiration event during UEI.