Gastric Cross-Sectional Area to Predict Gastric Intolerance in Critically Ill Patients: The Sono-ICU Prospective Observational Bicenter Study

Daniel El Khoury; Emmanuel Pardo; Amelie Cambriel; Francis Bonnet; Tai Pham; Bernard Cholley; Christophe Quesnel; Franck Verdonk

doi:10.1097/CCE.0000000000000882

Gastric Cross-Sectional Area to Predict Gastric Intolerance in Critically Ill Patients: The Sono-ICU Prospective Observational Bicenter Study

Crit Care Explor. 2023 Mar 20;5(3):e0882. doi: 10.1097/CCE.0000000000000882. eCollection 2023 Mar.

Authors

Daniel El Khoury¹, Emmanuel Pardo¹, Amelie Cambriel¹, Francis Bonnet¹, Tai Pham², Bernard Cholley³, Christophe Quesnel¹, Franck Verdonk¹

Affiliations

¹ Department of Anaesthesiology and Intensive Care, Hôpital Saint-Antoine Assistance Publique des Hôpitaux de Paris and Sorbonne University, GRC 29, DMU DREAM, Paris, France.
² Department of Intensive Care Medicine, Hôpital Kremlin Bicêtre Hospital and Paris Saclay University, Assistance Publique des Hôpitaux de Paris, Paris, France.
³ Department of Anaesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou-Assistance Publique Hôpitaux de Paris, and Université Paris Cité, INSERM, Innovative Therapies in Haemostasis, Paris, France.

Abstract

To evaluate the correlation between gastric cross-sectional area (GCSA) and the occurrence of gastric intolerance in critically ill patients within 24 hours of the measurement.

Design: Two-center prospective observational study.

Setting: Two academic ICUs in France between June 2020 and August 2021.

Patients: All surgical intubated ICU patients greater than or equal to 18 years old receiving enteral feeding for greater than 12 hours.

Interventions: None.

Measurements and main results: Forty-four patients were included, 11 (25%) of whom presented digestive intolerance. Primary outcome was assessment of the association between GCSA and the occurrence of gastric intolerance within 24 hours of the measurement. GCSA value was significantly higher in patients with upper digestive intolerance compared to those without (553 mm² [interquartile range (IQR), 500-649 mm²] vs 970 mm² [IQR, 777-1,047]; p < 0.001, respectively). The optimal threshold for predicting upper digestive intolerance was 720 mm² (area under the receiver operating characteristic curve 0.86; positive predictive value 62.5%; negative predictive value 96.4%; sensibility 0.91; and specificity 0.81). Multivariate analysis (weighted by propensity score), including known risk factors, showed that GCSA above the 720 mm² threshold was independently associated with the occurrence of upper digestive intolerance (odds ratio, 1.85; 1.37-2.49; p < 0.0002). Measurement quality was "good" (i.e., liver, aorta, superior mesenteric vein, and pancreas were all visualized) in 81% of cases.

Conclusions: Measurement of GCSA by ultrasound would allow prediction of gastric intolerance in critically ill patients. This should be confirmed by a prospective score validation and interventional trials.

Keywords: antral sonography; enteral feeding; gastric cross-sectional area; gastric intolerance; intensive care unit.