Airway Management, Emergency Surgery, Gastric Residual Volume, Pulmonary Aspiration of Gastric Contents
Conditions
Keywords
airway management, rapid sequence induction (RSI), gastric ultrasound, aspiration risk, emergency, point-of-care ultrasound (PoCUS)
Brief summary
This prospective observational cohort study evaluates the association between gastric residual content and volume, assessed by point-of-care gastric ultrasound (PoCUS), and the choice of airway management technique (Rapid Sequence Intubation vs. non Rapid Sequence Intubation) in adult emergency surgical patients at Rumah Sakit Cipto Mangunkusumo (RSCM). Aspiration risk in emergency patients is a critical concern, and this study examines whether objective ultrasonographic findings change clinical decision-making compared to traditional clinical assessment alone.
Detailed description
Emergency patients frequently have delayed gastric emptying, increasing aspiration risk during airway management. Gastric PoCUS allows non-invasive, bedside assessment of gastric content (empty, liquid, solid, or mixed) and volume. This study quantifies gastric antrum cross-sectional area (CSA) using the Perlas formula (GV = 27.0 + 14.6 × CSA - 1.28 × age) and reports whether USG findings influenced the anesthesiologist's plan (RSI or non-RSI).
Interventions
DEVICEPreoperative Gastric Point-of-Care Ultrasound (PoCUS)
Gastric antrum ultrasound performed using a low-frequency transducer (2-5 MHz; SonoSite M-Turbo or Lumify Philips) in the supine position before anesthetic induction. The antrum cross-sectional area (CSA) was measured during the relaxation phase between two peristaltic contractions, calculating cranio-caudal (CC) and antero-posterior (AP) diameters. Gastric residual volume (GRV) was calculated using the Perlas formula: GV = 27.0 + 14.6 × CSA - 1.28 × age (years). Gastric content was classified as empty, liquid, solid, or mixed. Aspiration risk was categorized as high (GRV ≥1.5 ml/kg or solid content) or low (GRV \<1.5 ml/kg or empty).
Sponsors
Indonesia University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Emergency patients requiring airway management in the Emergency Operating Room * Age \>18 years
Exclusion criteria
* Pregnancy * Morbid obesity (BMI \>40 kg/m²) * History of prior gastric or esophageal surgery * Duodenal tube in situ * Maxillofacial trauma or anticipated difficult airway * Inability to adequately visualize the gastric antrum on ultrasound
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Association between aspiration risk based on gastric ultrasound findings and airway management technique selection | At time of pre-induction assessment (single time point, intraoperative) | Proportion of patients in whom airway management technique (Rapid Sequence Intubation vs. non Rapid Sequence Intubation) was associated with aspiration risk category (high vs. low) determined by preoperative gastric Point-of-Care Ultrasound (PoCUS) findings. Aspiration risk classified as high if Gastric Residual Volume (GRV) ≥1.5 ml/kg or solid gastric content; low if GRV \<1.5 ml/kg or empty stomach. Analyzed using chi-square test. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Airway Management Plan After Gastric USG | Before and immediately after gastric USG, prior to anesthetic induction | Comparison of airway management plan (RSI vs. non-RSI) before and after disclosure of gastric USG findings to the treating anesthesiologist. Analyzed using McNemar's paired categorical test. |
| Gastric Residual Volume | At pre-induction assessment | Gastric residual volume calculated using the Perlas formula: GV = 27.0 + 14.6 × CSA - 1.28 × age (years), based on antrum cross-sectional area (CSA) measured from cranio-caudal (CC) and antero-posterior (AP) diameters. Reported as mean ± SD or median (range). |
| Gastric Content Type | At pre-induction assessment | Proportion of patients with each gastric content category: empty, liquid only, solid, or mixed (solid and liquid), as identified by gastric PoCUS. |
| Fasting Duration and Its Relationship to Gastric Residual Volume | At pre-induction assessment | Fasting duration categorized as \<8 hours, 8-12 hours, or \>12 hours since last solid food intake, and its relationship to gastric residual volume and aspiration risk classification on USG. |
| American Society of Anesthesiologists (ASA) Physical Status Classification as a factor in airway management decision | At pre-induction assessment | Proportion of patients in each American Society of Anesthesiologists (ASA) class (I, II, III, IV) and its association with airway management technique selection (RSI vs. non-RSI) after gastric USG, analyzed using chi-square test. |
| Trauma Severity Score (ISS) as a factor in airway management decision | At pre-induction assessment | Injury Severity Score (ISS) categorized as severe (ISS ≥15) or mild-moderate (ISS \<15) and its association with airway management technique selection (RSI vs. non-RSI) after gastric USG, analyzed using chi-square test. |
| Glasgow Coma Scale (GCS) score as a factor in airway management decision | At pre-induction assessment | GCS score recorded at pre-induction assessment and its association with airway management technique selection (RSI vs. non-RSI) after gastric USG. |
| Presence of clinical risk factors (sepsis, shock, GERD/gastritis) as a factor in airway management decision | At pre-induction assessment | Proportion of patients with each clinical risk factor (sepsis, hemorrhagic shock, GERD/gastritis) and its association with airway management technique selection (RSI vs. non-RSI) after gastric USG, analyzed using chi-square or Fisher's exact test. |
Countries
Indonesia
Outcome results
None listed