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Moake MM, Presley BC, Hill JG, et al. Point-of-Care Ultrasound to Assess Gastric Content in Pediatric Emergency Department Procedural Sedation Patients. Pediatr Emerg Care. 2022;38(1):e178-e186doi: 10.1097/PEC.0000000000002198.
Moake, M. M., Presley, B. C., Hill, J. G., Wolf, B. J., Kane, I. D., Busch, C. E., & Jackson, B. F. (2022). Point-of-Care Ultrasound to Assess Gastric Content in Pediatric Emergency Department Procedural Sedation Patients. Pediatric emergency care, 38(1), e178-e186. https://doi.org/10.1097/PEC.0000000000002198
Moake, Matthew M, et al. "Point-of-Care Ultrasound to Assess Gastric Content in Pediatric Emergency Department Procedural Sedation Patients." Pediatric emergency care vol. 38,1 (2022): e178-e186. doi: https://doi.org/10.1097/PEC.0000000000002198
Moake MM, Presley BC, Hill JG, Wolf BJ, Kane ID, Busch CE, Jackson BF. Point-of-Care Ultrasound to Assess Gastric Content in Pediatric Emergency Department Procedural Sedation Patients. Pediatr Emerg Care. 2022 Jan 01;38(1):e178-e186. doi: 10.1097/PEC.0000000000002198. PMID: 32769837; PMCID: PMC7854775.
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Pediatr Emerg Care. 2022 Jan 01;38(1):e178-e186. doi: 10.1097/PEC.0000000000002198.

Point-of-Care Ultrasound to Assess Gastric Content in Pediatric Emergency Department Procedural Sedation Patients.

Pediatric emergency care

Matthew M Moake, Bradley C Presley, Jeanne G Hill, Bethany J Wolf, Ian D Kane, Carrie E Busch, Benjamin F Jackson

Affiliations

  1. From the Department of Pediatric Emergency Medicine.
  2. Department of Emergency Medicine.
  3. Department of Pediatric Radiology.
  4. Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.

PMID: 32769837 PMCID: PMC7854775 DOI: 10.1097/PEC.0000000000002198

Abstract

OBJECTIVES: There is debate regarding the timing of procedural sedation and analgesia (PSA) in relation to fasting status. Point-of-care ultrasound (POCUS) provides the ability to measure gastric content and is being used as a surrogate for aspiration risk in anesthesia. We sought to evaluate the gastric content of pediatric emergency department (PED) patients undergoing PSA using POCUS.

METHODS: We performed a prospective observational study using a convenience sample of pediatric patients undergoing PSA between July 1, 2018, and June 30, 2019. Following a brief history, gastric content was measured using POCUS in both supine and right lateral decubitus positions at 2-hour intervals until the time of PSA. Qualitative content and calculated volume were classified based on the Perlas Model of anesthesia "Risk" assessment.

RESULTS: Ninety-three patients were enrolled with 61.3% male and mean age of 6.5 years. Gastric content was determined in 92 patients. There were 79.3% that had "high risk" content at the time of PSA, with a median fasting time of 6.25 hours and no serious adverse events. Fasting duration had a weak to moderate ability to predict "risk" category (area under the curve = 0.73), with no patient (n = 17) who underwent multiple evaluations awaiting PSA progressing from "high" to "low risk."

CONCLUSIONS: The majority of PED patients undergoing PSA at our institution had "high risk" gastric content with no clinically significant change occurring during serial evaluations. This calls into question the utility of delaying PSA based upon fasting status and lends support to a more comprehensive risk-benefit approach when planning pediatric PSA.

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Conflict of interest statement

Disclosure: The authors declare no conflict of interest.

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