L Zieleskiewicz1, M C Boghossian1, A C Delmas1, L Jay2, A Bourgoin1, X Carcopino3, M Poirier1, B Cogniat2, A Stewart4, D Chassard5, M Leone6, L Bouvet7. 1. Department of Anaesthesia and Intensive Care, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Chemin des Bourrely, Marseille 13015, France. 2. Department of Anaesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, Bron 69500, France. 3. Department of Obstetrics and Gynaecology, Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, IMBE, Aix Marseille Université (AMU), CNRS, IRD, 58 Boulevard Charles Livon, Marseille 13284, France. 4. Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK. 5. Department of Anaesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, Bron 69500, France University of Lyon, Claude Bernard Lyon 1 University, 43 boulevard du 11 Novembre 1918, Villeurbanne 69100, France. 6. Department of Anaesthesia and Intensive Care, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Chemin des Bourrely, Marseille 13015, France Aix Marseille University, 58 Boulevard Charles Livon, Marseille 13284, France. 7. Department of Anaesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, Bron 69500, France Inserm, U1032, LabTau, 151, cours Albert Thomas, Lyon 69003, France lionel.bouvet@chu-lyon.fr.
Abstract
BACKGROUND: The aim of this prospective observational study was to assess the performance of ultrasonographic gastric antral area (GAA) to predict gastric fluid volumes of >0.4, >0.8 and >1.5 ml kg(-1), in fasted women in established labour. METHODS: A first ultrasound examination of the antrum was performed, in order to confirm gastric vacuity by using a qualitative score. Baselines GAA measurements were obtained in both supine and right lateral decubitus positions. Thereafter, parturients were allowed to drink clear fluids only. Measurement of GAA was repeated 15 min after last fluid intake, in both supine and right lateral positions. Receiver operating characteristics (ROC) curves were constructed to determine the accuracy of GAA to diagnose ingested volumes of >0.4, >0.8 and >1.5 ml kg(-1). RESULTS: Data from forty parturients were analysed. The areas under the ROC curves ranged from 80% to 86%. The cut-off value for antral area measured in supine position, to detect a volume >0.4 ml kg(-1), was 387 mm(2), with a sensitivity of 87%, a specificity of 70% and a negative predictive value of 85%. A cut-off value of 608 mm(2) predicted a fluid volume >1.5 ml kg(-1), with a specificity of 94%, a sensitivity of 75% and a negative predictive value of 92%. CONCLUSIONS: This study provides cut-off values for GAA that could be used in addition to the qualitative assessment of the antrum to define a full stomach in labouring patients.
BACKGROUND: The aim of this prospective observational study was to assess the performance of ultrasonographic gastric antral area (GAA) to predict gastric fluid volumes of >0.4, >0.8 and >1.5 ml kg(-1), in fasted women in established labour. METHODS: A first ultrasound examination of the antrum was performed, in order to confirm gastric vacuity by using a qualitative score. Baselines GAA measurements were obtained in both supine and right lateral decubitus positions. Thereafter, parturients were allowed to drink clear fluids only. Measurement of GAA was repeated 15 min after last fluid intake, in both supine and right lateral positions. Receiver operating characteristics (ROC) curves were constructed to determine the accuracy of GAA to diagnose ingested volumes of >0.4, >0.8 and >1.5 ml kg(-1). RESULTS: Data from forty parturients were analysed. The areas under the ROC curves ranged from 80% to 86%. The cut-off value for antral area measured in supine position, to detect a volume >0.4 ml kg(-1), was 387 mm(2), with a sensitivity of 87%, a specificity of 70% and a negative predictive value of 85%. A cut-off value of 608 mm(2) predicted a fluid volume >1.5 ml kg(-1), with a specificity of 94%, a sensitivity of 75% and a negative predictive value of 92%. CONCLUSIONS: This study provides cut-off values for GAA that could be used in addition to the qualitative assessment of the antrum to define a full stomach in labouring patients.