Delia and Lianne discuss the use of gastric ultrasound in pediatric sedation, highlighting the challenges of fasting and assessing gastric content. They explore the benefits and limitations of using Point-of-Care Ultrasound to categorize patients based on gastric content volume. The study reveals the weak predictive value of fasting duration in determining sedation risk categories and emphasizes the importance of gastric ultrasound in high-risk patients.
Gastric POCUS can identify high-risk gastric content in pediatric sedation patients, challenging the reliability of fasting guidelines.
Evidence-based sedation practices should consider gastric content assessment to mitigate aspiration risk post-procedure.
Deep dives
Study on Gastric Ultrasound for Pediatric Sedation Patients
A recent study focused on using point-of-care ultrasound to assess gastric contents in pediatric emergency department procedural sedation patients. The study demonstrated that 80% of patients had high-risk gastric content based on the Peralos model, regardless of meeting ASA fasting guidelines. Serial ultrasound examinations showed no significant change in gastric volumes, and the incidence of aspiration post-sedation aligned with previous studies. This highlights the importance of assessing gastric content for sedation safety.
Fasting Time Does Not Predict Gastric Content
Despite following ASA fasting guidelines, over 60% of patients considered fasting still had high-risk gastric content. This challenges the use of fasting time as a reliable predictor of low-risk gastric content in the pediatric emergency department. The study suggests a need for further research to determine the relationship between high-risk gastric content and post-procedural aspiration, emphasizing the complexity of balancing risk factors, urgency, and medication plans in sedation practice.
Implications for Sedation Practices and Future Research
The study prompts reflection on sedation practices in emergency departments, questioning the traditional reliance on NPO status for procedural sedation. With most patients exhibiting high-risk gastric content even after fasting, the study advocates for a shift towards more evidence-based sedation approaches. Further investigations are warranted to explore the potential impact of high-risk gastric content on post-procedural outcomes and the safety of proceeding with sedation irrespective of NPO status, emphasizing the need for a nuanced approach in sedation decision-making.
Delia and Lianne take on the topic of pediatric gastric POCUS. Is it a helpful way to assess the effect of fasting prior to procedural sedation? Is fasting itself a helpful way to empty the stomach??