Gastric volume and antral area in the fasting state. A meta-analysis of individual patient data.

January 30, 2024 by Dr. Clemens Leave a Comment

Background

Pulmonary aspiration of gastric content is a serious anesthetic complication. Gastric point-of-care ultrasound can determine the type and volume of gastric content when clinical information is equivocal. However, a cut-off value of either antral cross-sectional area or volume that may be considered as the upper limit of normal in fasting subjects is still controversial. The aim of this study is to characterize the distribution of baseline antral area and volume in fasting adult subjects and to identify an upper limit (95^th percentile) of these distributions.

Methods

We conducted a meta-analysis of individual participant data of primary studies from an academic research network of investigators collaborating in gastric ultrasound. Studies between January 2009 and December 2020 were included.

Results

Twelve primary studies met inclusion criteria and were included in the analysis with a sample size of 1,203 subjects. The 95^th percentile of area values (measured in the right lateral decubitus) was 9.9 cm² (95% CI 9.4-10.4), and of volume 2.3 mL/Kg (95% CI 2.3-2.4). In addition an antrum grade 0 or 1 indicates a 98% probability of an antral area below the 95^th percentile.

Conclusions

An area of 10 cm² measured in the right lateral decubitus could be a simple, data-driven upper limit of antral area that could serve as a surrogate of upper limit of normal gastric volume values in fasting adults. These results are limited by the highly selected sampling of the studies included.

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