Clinical recognition of a potentially full stomach and use of point-of-care gastric ultrasound (POCUS) by anesthesiologists: a Belgian survey

Abstract

Abstract Background: Pulmonary aspiration syndrome remains a noteworthy complication of general anesthesia, particularly in unfasted patients. Ensuring a high degree of certainty regarding gastric emptiness is strongly associated with a reduction in the likelihood of pulmonary aspiration. Gastric point-of-care ultrasound (POCUS) allows both qualitative and quantitative assessment of gastric contents. Methods: The survey, created and approved by two certified anesthesiologists trained to perform gastric POCUS, was distributed to Belgian certified anesthesiologists and trainees between April 2020 and June 2021. Participants were provided with a simulated clinical case of a patient at risk for gastric aspiration according to his medical history. The objective of this study was to assess the identification of clinical high-risk situations for gastric aspiration, the importance of the gastric POCUS criteria, the importance of understanding the technical and practical features of the procedure, and the potential impact of the procedure on the induction plan for general anesthesia. The survey utilized conditional branching to ensure unbiased responses to POCUS-related questions. The questionnaire included multiple-choice questions, quantitative variables, and 5-point Likert scales. Daniel's formula, corrected for a finite population, was used to calculate the margin of error. Results: The survey was completed by 323 anesthesiologists. Among them, only 20.8% (27) identified the risk of a full stomach based on the patient's history. Anesthesiologists who recognized the indication for gastric POCUS and were trained in the procedure demonstrated good recall of the practical conditions for performing the procedure and interpreting the results. Only 13.08% (31) of all respondents had received training in gastric POCUS, while 72.57% (172) expressed interest in future training. Additionally, 80.17% (190) of the participants had access to adequate ultrasound equipment, and 78.90% (187) endorsed teaching gastric POCUS to anesthesiology trainees. Conclusions: This survey provides insight into the epidemiology, clinical recognition, knowledge, and utilization of gastric POCUS among Belgian anesthesia professionals. The results highlight the importance of appropriate equipment and training to ensure the safe and effective implementation of gastric POCUS in anesthesia practice. Additional efforts should focus on enhancing training and encouraging the integration of gastric POCUS into daily clinical practice.