Gastric ultrasound to predict intolerance to enteral nutritional support: a prospective cohort
Abstract
Introduction: Bedside-focused ultrasound has opened new avenues for monitoring critically ill patients. Measurement of the gastric antral area (GAA) and residual gastric volume (RGV) have been proposed as predictors of intolerance to enteral nutritional support (ENS).
Objectives: To assess the diagnostic performance of GAA and RGV via ultrasound for predicting ENS intolerance.
Methods: Prospective cohort of critically ill patients receiving enteral nutrition via a prepyloric tube (≥12 hours). Gastric ultrasound was performed once daily ≥6 hours after nutritional support initiation, with measurements taken in the supine (SP) and right lateral decubitus (RLD) positions. Patients were followed for 24 hours to assess ENS intolerance.
Results: A total of 57 patients contributed 310 measurements (155 SP and 155 RLD). ENS intolerance occurred in 9 cases (5.8%). The frequency of posterior acoustic shadowing in RLD and SP was similar (19.3% vs. 21.9%; p = 0.393), but qualitative measurement concordance between RLD and SP was poor (Kappa = 0.43). Only RGV in SP showed good predictability for ENS intolerance (AUC-ROC 0.71; 95% CI 0.51–0.92) vs. RGV in RLD (AUC-ROC 0.55; 95% CI 0.32–0.79). The best SP cutoff points for ENS intolerance were a GAA of 5.48 cm² (Se 88% – Sp 58%) and an RGV of 33.3 mL (Se 75% – Sp 64%).
Conclusions: Ultrasound single and random measurement of GAA and RGV performed poorly in predicting ENS intolerance in critically ill patients; however, the results could have been influenced by the low frequency of the events.
References
1. Blaser AR, Starkopf J, Kirsimägi Ü, Deane AM. Definition, prevalence, and outcome of feeding intolerance in intensive care: a systematic review and meta-analysis. Acta Anaesthesiol Scand. 2014;58(8):914-22. https://doi.org/10.1111/aas.12302
2. Al-Dorzi HM, Arabi YM. Nutrition support for critically iII patients. JPEN J Parenter Enteral Nutr. 2021;45(S2):47-59. https://doi.org/10.1002/jpen.2228
3. Allen K, Hoffman L. Enteral nutrition in the mechanically ventilated patient. Nutr Clin Pract Off Publ Am Soc Parenter Enter Nutr. 2019;34(4):540-57. https://doi.org/10.1002/ncp.10242
4. Compher C, Bingham AL, McCall M, Patel J, Rice TW, Braunschweig C, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2022;46(1):12-41. https://doi.org/10.1002/jpen.2267
5. Jenkins B, Calder PC, Marino LV. A systematic review of the definitions and prevalence of feeding intolerance in critically ill adults. Clin Nutr ESPEN. 2022;49:92-102. https://doi.org/10.1016/j.clnesp.2022.04.014
6. McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40(2):159-211. https://doi.org/10.1177/0148607115621863
7. Wang Z, Ding W, Fang Q, Zhang L, Liu X, Tang Z. Effects of not monitoring gastric residual volume in intensive care patients: A meta-analysis. Int J Nurs Stud. 2019;91:86-93. https://doi.org/10.1016/j.ijnurstu.2018.11.005
8. Van de Putte P, Perlas A. Ultrasound assessment of gastric content and volume. Br J Anaesth. 2014;113(1):12-22. https://doi.org/10.1093/bja/aeu151
9. Sharma V, Gudivada D, Gueret R, Bailitz J. Ultrasound-Assessed gastric antral area correlates with aspirated tube feed volume in enterally fed critically Ill patients. Nutr Clin Pract Off Publ Am Soc Parenter Enter Nutr. 2017;32(2):206-11. https://doi.org/10.1177/0884533616681530
10. Lai J, Chen S, Chen L, Huang D, Lin J, Zheng Q. Bedside gastrointestinal ultrasound combined with acute gastrointestinal injury score to guide enteral nutrition therapy in critically patients. BMC Anesthesiol. 2022;22(1):231. https://doi.org/10.1186/s12871-022-01772-9
11. El Khoury D, Pardo E, Cambriel A, Bonnet F, Pham T, Cholley B, et al. Gastric cross-sectional area to predict gastric intolerance in critically Ill patients: The Sono-ICU prospective observational bicenter study. Crit Care Explor. 2023;5(3):e0882. https://doi.org/10.1097/CCE.0000000000000882
12. Perlas A, Chan VWS, Lupu CM, Mitsakakis N, Hanbidge A. Ultrasound assessment of gastric content and volume. Anesthesiology. 2009;111(1):82-9. https://doi.org/10.1097/ALN.0b013e3181a97250
13. Reintam Blaser A, Deane AM, Preiser JC, Arabi YM, Jakob SM. Enteral feeding intolerance: updates in definitions and pathophysiology. Nutr Clin Pract Off Publ Am Soc Parenter Enter Nutr. 2021;36(1):40-9. https://doi.org/10.1002/ncp.10599
14. Bujang MA, Adnan TH. Requirements for minimum sample size for sensitivity and specificity analysis. J Clin Diagn Res JCDR. 2016;10(10):YE01-6. https://doi.org/10.7860/JCDR/2016/18129.8744
15. Ali Z, Bhaskar SB. Basic statistical tools in research and data analysis. Indian J Anaesth. 2016;60(9):662-9. https://doi.org/10.4103/0019-5049.190623
16. Whitley E, Ball J. Statistics review 3: hypothesis testing and P values. Crit Care Lond Engl. 2002;6(3):222-5. https://doi.org/10.1186/cc1493
17. Carter JV, Pan J, Rai SN, Galandiuk S. ROC-ing along: Evaluation and interpretation of receiver operating characteristic curves. Surgery. 2016;159(6):1638-45. https://doi.org/10.1016/j.surg.2015.12.029
18. Fluss R, Faraggi D, Reiser B. Estimation of the Youden Index and its associated cutoff point. Biom J Biom Z. 2005;47(4):458-72. https://doi.org/10.1002/bimj.200410135
19. Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 1983;148(3):839-43. https://doi.org/10.1148/radiology.148.3.6878708
20. Bouvet L, Mazoit JX, Chassard D, Allaouchiche B, Boselli E, Benhamou D. Clinical assessment of the ultrasonographic measurement of antral area for estimating preoperative gastric content and volume. Anesthesiology. 2011;114(5):1086-92. https://doi.org/10.1097/ALN.0b013e31820dee48
21. Yu G, Jin S, Wang R, Lu J, Wang R. Transabdominal gastro-intestinal ultrasonography (TGIU) for predicting feeding intolerance in critically ill patients: A prospective observational study. Clin Nutr ESPEN. 2023;55:76-82. https://doi.org/10.1016/j.clnesp.2023.02.010
22. Wang L, Yang H, Lv G, Fu X, Cheng Y, Zhong X, et al. Association of gastric antrum echodensity and acute gastrointestinal injury in critically Ill patients. Nutrients. 2022;14(3):566. https://doi.org/10.3390/nu14030566
23. Ankalagi B, Singh PM, Rewari V, Ramachandran R, Aggarwal R, Soni KD, et al. Serial ultrasonographic-measurement of gastric residual volume in critically Ill patients for prediction of gastric tube feed intolerance. Indian J Crit Care Med Peer-Rev Off Publ Indian Soc Crit Care Med. 2022;26(9):987-92. https://doi.org/10.5005/jp-journals-10071-24296
24. Yu K, Guo N, Zhang D, Xia Y, Meng Y, Weng L, et al. Prevalence and risk factors of enteral nutrition intolerance in intensive care unit patients: a retrospective study. Chin Med J (Engl). 2022;135(15):1814-20. https://doi.org/10.1097/CM9.0000000000001974
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