Gastric Cross-Sectional Area to Predict Gastric Intolerance in Critically Ill Patients: The Sono-ICU Prospective Observational Bicenter Study

Daniel El Khoury, MD; Emmanuel Pardo, MD; Amelie Cambriel, MD; Francis Bonnet, MD, PhD; Tai Pham, MD; Bernard Cholley, MD, PhD; Christophe Quesnel, MD, PhD; Franck Verdonk, MD, PhD

doi:10.1097/CCE.0000000000000882

Critical Care Explorations (Mar 2023)

Gastric Cross-Sectional Area to Predict Gastric Intolerance in Critically Ill Patients: The Sono-ICU Prospective Observational Bicenter Study

Daniel El Khoury, MD,
Emmanuel Pardo, MD,
Amelie Cambriel, MD,
Francis Bonnet, MD, PhD,
Tai Pham, MD,
Bernard Cholley, MD, PhD,
Christophe Quesnel, MD, PhD,
Franck Verdonk, MD, PhD

Affiliations

Daniel El Khoury, MD: 1 Department of Anaesthesiology and Intensive Care, Hôpital Saint-Antoine Assistance Publique des Hôpitaux de Paris and Sorbonne University, GRC 29, DMU DREAM, Paris, France.
Emmanuel Pardo, MD: 1 Department of Anaesthesiology and Intensive Care, Hôpital Saint-Antoine Assistance Publique des Hôpitaux de Paris and Sorbonne University, GRC 29, DMU DREAM, Paris, France.
Amelie Cambriel, MD: 1 Department of Anaesthesiology and Intensive Care, Hôpital Saint-Antoine Assistance Publique des Hôpitaux de Paris and Sorbonne University, GRC 29, DMU DREAM, Paris, France.
Francis Bonnet, MD, PhD: 1 Department of Anaesthesiology and Intensive Care, Hôpital Saint-Antoine Assistance Publique des Hôpitaux de Paris and Sorbonne University, GRC 29, DMU DREAM, Paris, France.
Tai Pham, MD: 2 Department of Intensive Care Medicine, Hôpital Kremlin Bicêtre Hospital and Paris Saclay University, Assistance Publique des Hôpitaux de Paris, Paris, France.
Bernard Cholley, MD, PhD: 3 Department of Anaesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou—Assistance Publique Hôpitaux de Paris, and Université Paris Cité, INSERM, Innovative Therapies in Haemostasis, Paris, France.
Christophe Quesnel, MD, PhD: 1 Department of Anaesthesiology and Intensive Care, Hôpital Saint-Antoine Assistance Publique des Hôpitaux de Paris and Sorbonne University, GRC 29, DMU DREAM, Paris, France.
Franck Verdonk, MD, PhD: 1 Department of Anaesthesiology and Intensive Care, Hôpital Saint-Antoine Assistance Publique des Hôpitaux de Paris and Sorbonne University, GRC 29, DMU DREAM, Paris, France.

DOI: https://doi.org/10.1097/CCE.0000000000000882
Journal volume & issue: Vol. 5, no. 3
p. e0882

Abstract

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OBJECTIVES:. To evaluate the correlation between gastric cross-sectional area (GCSA) and the occurrence of gastric intolerance in critically ill patients within 24 hours of the measurement. DESIGN:. Two-center prospective observational study. SETTING:. Two academic ICUs in France between June 2020 and August 2021. PATIENTS:. All surgical intubated ICU patients greater than or equal to 18 years old receiving enteral feeding for greater than 12 hours. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Forty-four patients were included, 11 (25%) of whom presented digestive intolerance. Primary outcome was assessment of the association between GCSA and the occurrence of gastric intolerance within 24 hours of the measurement. GCSA value was significantly higher in patients with upper digestive intolerance compared to those without (553 mm2 [interquartile range (IQR), 500–649 mm2] vs 970 mm2 [IQR, 777–1,047]; p < 0.001, respectively). The optimal threshold for predicting upper digestive intolerance was 720 mm2 (area under the receiver operating characteristic curve 0.86; positive predictive value 62.5%; negative predictive value 96.4%; sensibility 0.91; and specificity 0.81). Multivariate analysis (weighted by propensity score), including known risk factors, showed that GCSA above the 720 mm2 threshold was independently associated with the occurrence of upper digestive intolerance (odds ratio, 1.85; 1.37–2.49; p < 0.0002). Measurement quality was “good” (i.e., liver, aorta, superior mesenteric vein, and pancreas were all visualized) in 81% of cases. CONCLUSIONS:. Measurement of GCSA by ultrasound would allow prediction of gastric intolerance in critically ill patients. This should be confirmed by a prospective score validation and interventional trials.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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