Aspiration Pneumonia, Critical Illness, Surgery
Conditions
Keywords
NPO Protocols, Intensive Care Unit, Gastric Ultrasound, Ultrasound, Surgical Intensive Care Unit, NPO, Nasogastric Tube, Orogastric Tube, Enteral Nutrition, Parenteral Nutrition, Gastric Residual Volume, Aspiration, Critical Illness Nutrition
Brief summary
This is a case series study using gastric ultrasound in critically ill patients to quantify gastric residual volumes to compare the efficacy of different NPO protocols.
Interventions
DIAGNOSTIC_TESTGastric Ultrasound
Gastric ultrasound in the supine and right lateral decubitus position for patients going for operative intervention with a protected airway.
Sponsors
Dartmouth-Hitchcock Medical Center
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SCREENING
Masking
NONE
Intervention model description
Patients will be assigned to be NPO after midnight (standard protocol) or feed up until call to OR then decompressed (liberal protocol).
Eligibility
Sex/Gender
ALL
Age
18 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
* Patients age 18 or older, admitted to the ICU, requiring general anesthesia or sedation for a procedure with a pre-existing, cuffed endotracheal or tracheostomy tube. Most patients admitted to the ICU would be unable to consent.
Exclusion criteria
* Known upper gastrointestinal anatomical problem that would prevent accurate estimation of gastric volume, gastric perforation, pregnancy beyond the first trimester. * Lack of a pre-existing, cuffed endotracheal or tracheostomy tube.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Gastric Residual Volumes | Within one hour of operative intervention. | Quantification of gastric residual volumes as measured in milliliters using antral cross-sectional areas and semi-quantitative gastric volumes using standardized grading scores. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Comparison of two different NPO protocol populations | Within four months of study completion, 16 months from study start | Comparing standard ASA NPO protocol vs liberal, feed-up-until-call to OR protocol as defined by comparison of gastric volumes (mLs). |
| Peri-operative aspiration events | Within four months of study completion, 16 months from study start | Number of aspiration events per number of operative interventions. |
| Estimation of the amount of enteral nutrition lost prior to surgery using the different NPO protocols | Zero to sixteen hours prior to surgery | Calculation of enteral nutrition held during NPO time in kilocalories. |
Countries
United States
Contacts
Primary ContactLaura M Chiang, MD
Backup ContactLaura M Chiang, MD
Outcome results
None listed