Assessing Gastric Motility and Distention in Postoperative Gastrointestinal Surgery Using Bedside Gastric Ultrasound: Predicting Risk of Aspiration Pneumonia, Ileus, Return of Bowel Function
Study Details
Study Description
Brief Summary
Point-of-care gastric ultrasound will be used to measure stomach contents postoperative in patients who underwent colorectal surgery. Stomach volume and status (empty or full) will be compared retrospectively to the standard clinical criteria for diet advancement to determine if stomach volume via ultrasound is associated with successful diet advancement, nausea/vomiting, nasogastric tube replacement, length of stay, and other clinical outcomes. Clinicians performing clinical care will be blinded to the ultrasound exam results.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Detailed Description
Patient population: Patients undergoing colorectal surgery will be enrolled prospectively (both cancer and non-cancer patients).
Inclusion Criteria:
-
Patients aged > 18 years of age
-
Patients undergoing colorectal surgery (both cancer and non-cancer)
Exclusion Criteria:
-
Patients < 18 years of age
-
Patients with previous gastric surgery
-
Patients with inadequate or difficult baseline gastric ultrasound images
-
Any other patient deemed a poor study candidate by the treating physicians
Research Design/Protocol: We will perform postoperative point-of-care ultrasound examinations in colorectal surgery patients and will record gastric volumes at set time points, including preoperative and the morning of postoperative day 1. The surgical team, who will be blinded to the results of the ultrasound exam, will make decisions to advance diet, remove nasogastric tube, and begin oral medications based on standard clinical criteria. At the completion of the study we will determine if there is any association between gastric volume on ultrasound and patient complications, such as nausea/vomiting, replacement of nasogastric tube, aspiration of gastric contents, inability to tolerate solid diet, prolonged admission/length of stay, and other clinical outcomes.
Outcomes: Our exploratory outcome measures will be tolerance of diet, replacement of NG tube, nausea/vomiting, time to flatus, aspiration pneumonia/pneumonitis, and length of stay.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Patients assessed with postoperative bedside gastric ultrasound This patient population will include postoperative patients who received a gastrointestinal surgery and are being assessed with the bedside gastric ultrasound. |
Diagnostic Test: Bedside gastric ultrasound
Bedside ultrasound exam of the stomach
|
Outcome Measures
Primary Outcome Measures
- Tolerance of diet advancement [0 - 14 days]
Includes replacement of NGT, downgrading diet
Secondary Outcome Measures
- Emesis [0 - 14 days]
- Time to first flatus [0 - 14 days]
- Aspiration pneumonitis [0 - 14 days]
Clinical or radiographic evidence of aspiration
- Time to first bowel movement [0 - 14 days]
Other Outcome Measures
- Nausea [0 - 14 days]
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Patients aged > 18 years of age
-
Patients undergoing colorectal surgery (both cancer and non-cancer)
Exclusion Criteria:
-
Patients < 18 years of age
-
Patients with previous gastric surgery
-
Patients with difficult or poor ultrasound images at baseline
-
Any patient deemed a poor candidate by the treating physicians
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Thomas Jefferson University Hospital | Philadelphia | Pennsylvania | United States | 19107 |
Sponsors and Collaborators
- Eric Schwenk
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
- Barletta JF, Senagore AJ. Reducing the burden of postoperative ileus: evaluating and implementing an evidence-based strategy. World J Surg. 2014 Aug;38(8):1966-77. doi: 10.1007/s00268-014-2506-2. Review.
- Gola W, Domagała M, Cugowski A. Ultrasound assessment of gastric emptying and the risk of aspiration of gastric contents in the perioperative period. Anaesthesiol Intensive Ther. 2018;50(4):297-302. doi: 10.5603/AIT.a2018.0029. Epub 2018 Sep 17. Review.
- Haskins SC, Kruisselbrink R, Boublik J, Wu CL, Perlas A. Gastric Ultrasound for the Regional Anesthesiologist and Pain Specialist. Reg Anesth Pain Med. 2018 Oct;43(7):689-698. doi: 10.1097/AAP.0000000000000846. Review.
- Mirbagheri N, Dunn G, Naganathan V, Suen M, Gladman MA. Normal Values and Clinical Use of Bedside Sonographic Assessment of Postoperative Gastric Emptying: A Prospective Cohort Study. Dis Colon Rectum. 2016 Aug;59(8):758-65. doi: 10.1097/DCR.0000000000000637.
- Sabaté S, Mazo V, Canet J. Predicting postoperative pulmonary complications: implications for outcomes and costs. Curr Opin Anaesthesiol. 2014 Apr;27(2):201-9. doi: 10.1097/ACO.0000000000000045. Review.
- Vather R, O'Grady G, Bissett IP, Dinning PG. Postoperative ileus: mechanisms and future directions for research. Clin Exp Pharmacol Physiol. 2014 May;41(5):358-70. doi: 10.1111/1440-1681.12220. Review.
- Warner MA, Warner ME, Weber JG. Clinical significance of pulmonary aspiration during the perioperative period. Anesthesiology. 1993 Jan;78(1):56-62.
- Wolthuis AM, Bislenghi G, Fieuws S, de Buck van Overstraeten A, Boeckxstaens G, D'Hoore A. Incidence of prolonged postoperative ileus after colorectal surgery: a systematic review and meta-analysis. Colorectal Dis. 2016 Jan;18(1):O1-9. doi: 10.1111/codi.13210. Review.
- Zhang X, Zheng W, Chen C, Kang X, Zheng Y, Bao F, Gan S, Zhu S. Goal-directed fluid therapy does not reduce postoperative ileus in gastrointestinal surgery: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018 Nov;97(45):e13097. doi: 10.1097/MD.0000000000013097. Review.
- 20D.1009