2024 FSA Podium and Poster Abstracts
P048: ACUTE NEUROLOGIC INJURY AND GASTRIC DYSMOTILITY: IS POINT OF CARE GASTRIC ULTRASOUND (POCGUS) A USEFUL INTERVENTION?
Olivia Scheuermann, BS1; Austin Kansol, BS1; Brandon Lucke-Wold, MD, PhD2; Cameron Smith, MD, PhD3; Matthew Decker, MD2; Nikolaus Gravenstein, MD3; Meghan Brennan, MD, MS3; 1University of Florida College of Medicine; 2University of Florida College of Medicine, Department of Neurosurgery; 3University of Florida College of Medicine, Department of Anesthesiology
Introduction: Patients admitted to surgical ICUs are frequently kept nil per os (NPO) and fed via a post-pyloric feeding tube to limit aspiration risk. Yet, aspiration during sedation and anesthesia is still a devastating complication in the neuro-critically ill patient population and leads to significant morbidity and mortality. Patients with acute neurological disease may be predisposed to gastrointestinal (GI) complications such as gastric dysmotility, delayed gastric emptying, and ileus, increasing aspiration risk. ?Given the increasing availability of point of care (POC) ultrasound, we aimed to use POC ultrasound to characterize gastric contents in neuro-critically ill patients before and after initiation of post pyloric tube feeds, to potentially clarify the use of this intervention in this patient population, consider how fasting guidelines may apply, and explore the possible mechanisms underlying why these GI complications occur. We also aimed to determine if POCGUS is a feasible intervention to evaluate stomach contents at the bedside and make a clinical assessment of aspiration risk.
Methods: Thirteen patients with neurologic injury were identified as a subset of a larger single center ongoing prospective observational prospective cohort study involving 54 adult patients admitted to surgical ICUs. POCGUS was performed prior to initiation of enteral feeds and after feeds had been ongoing at goal rate for at least 6 hours. Ultrasound images were obtained in both the supine and right lateral decubitus positions to identify the gastric antrum, qualitatively characterize its contents (empty vs full [solid vs liquid]). ?Three patients were further reviewed for case demonstration: subarachnoid hemorrhage (SAH), acute ischemic stroke (AIS), and subdural hematoma (SDH).
Results: We determined that 6 out of 13 patients with acute neurologic injury characterized as NPO had full stomachs on pre-feed imaging. Out of the patients that successfully obtained a pre and post image, 33% (2/6) patients classified as full on pre imaging became empty on post imaging. 33% (2/6) patients remained empty. 0% (0/6) patients classified as empty were full on post imaging. 33% (2/6) patients remained full. ?Of the three patients selected for further case analysis,?100% (3/3) had full stomachs on pre-feed imaging. 66.7% (2/3) patients had full stomachs on post-feed imaging.
Discussion: Possible mechanisms were applied to explain the findings of these respective cases including increased ICP, induced autonomic nervous system dysfunction, inflammatory changes of the gut-brain axis due to the systemic effects of neuronal damage, and neuromuscular dysfunction of the stomach. ?Neurologic injury likely predisposes patients to gastric dysmotility. POCGUS is a minimally invasive intervention that may be useful in quickly and easily assessing aspiration risk and intolerance to enteral feeding in patients with CNS induced GI dysfunction. POCGUS may also be able to guide further treatment decisions, such as the need for the administration of promotility agents. ?Challenges included poor ultrasound image quality, operating system incompatibility with ultrasound, and delays prior to feeding tube placement. When reviewing image quality, the highest quality ultrasounds were of patients with a normal BMI and with minimal postoperative abdominal air.