2 research outputs found
Sonographic Evaluation of Gastric Residual Volume during Enteral Nutrition in Critically Ill Patients Using a Miniaturized Ultrasound Device
Background: To assess the risk of aspiration, nutrient tolerance, and gastric emptying
of patients in ICUs, gastric ultrasound can provide information about the gastric contents. Using
established formulas, the gastric residual volume (GRV) can be calculated in a standardized way by
measuring the gastric antrum. The purpose of this study was to determine the GRV in a cohort of
enterally fed patients using a miniaturized ultrasound device to achieve knowledge about feasibility
and the GRV over time during the ICU stay. The findings could contribute to the optimization of en teral nutrition (EN) therapy. Methods: A total of 217 ultrasound examinations with 3 measurements
each (651 measurements in total) were performed twice daily (morning and evening) in a longitudinal
observational study on 18 patients with EN in the interdisciplinary surgical ICU of Saarland Univer sity Medical Center. The measured values of the GRV were analyzed in relation to the clinical course,
the nutrition, and other parameters. Results: Measurements could be performed without interrupting
the flow of clinical care and without pausing EN. The GRV was significantly larger with sparsely
auscultated bowel sounds than with normal and excited bowel sounds (p < 0.01). Furthermore, a
significantly larger GRV was present when using a high-caloric/low-protein nutritional product
compared to an isocaloric product (p = 0.02). The GRV at the morning and evening measurements
showed no circadian rhythm. When comparing the first and last ultrasound examination of each
patient, there was a tendency towards an increased GRV (p = 0.07). Conclusion: The GRV measured
by miniaturized ultrasound devices can provide important information about ICU patients without
restricting treatment procedures in the ICU. Measurements are possible while EN therapy is ongoing.
Further studies are needed to establish gastric ultrasound as a management tool in nutrition therapy
Real-Time Evaluation of Optic Nerve Sheath Diameter (ONSD) in Awake, Spontaneously Breathing Patients
(1) Background: Reliable ultrasonographic measurements of optic nerve sheath diameter
(ONSD) to detect increased intracerebral pressure (ICP) has not been established in awake patients
with continuous invasive ICP monitoring. Therefore, in this study, we included fully awake patients with and without raised ICP and correlated ONSD with continuously measured ICP values.
(2) Methods: In a prospective study, intracranial pressure (ICP) was continuously measured in
25 patients with an intraparenchymatic P-tel probe. Ultrasonic measurements were carried out three
times for each optic nerve in vertical and horizontal directions. ONSD measurements and ICP were
correlated. Patients with ICP of 2.0–10.0 mmHg were compared with patients suffering from an ICP
of 10.1–24.2 mmHg. (3) Results: In all patients, the ONSD vertical and horizontal measurement for
both eyes correlated well with the ICP (Pearson R = 0.68–0.80). Both measurements yielded similar
results (Bland-Altman: vertical bias: −0.09 mm, accuracy: ±0.66 mm; horizontal bias: −0.06 mm,
accuracy: ±0.48 mm). For patients with an ICP of 2.0–10.0 mmHg compared to an ICP of 10.1–24.2,
ROC (receiver operating characteristic) analyses showed that ONSD measurement accurately predicts elevated ICP (optimal cut-off value 5.05 mm, AUC of 0.91, sensitivity 92% and specificity
90%, p < 0.001). (4) Conclusions: Ultrasonographic measurement of ONSD in awake, spontaneously
breathing patients provides a valuable method to evaluate patients with suspected increased ICP.
Additionally, it provides a potential tool for rapid assessment of ICP at the bedside and to identify
patients at risk for a poor neurological outcome