Gastric ultrasound for feeding intolerance in the ICU: close but not quite right.

In the January 2021 issue of BMC Gastroenterology, Elmokadem et al. report their findings on the use of gastric ultrasound (GUS) for the evaluation of feeding intolerance-defined as high gastric residual volume-in critically ill patients. We voice in this correspondence our concerns regarding certain methodological flaws and believe the study results should be interpreted with caution. The authors applied a model unvalidated for non-clear fluids as enteral feeding, the scanning protocol was not clearly described and essential anatomical landmarks required for correct interpretation are not visible in the presented images. Additionally, since GUS was not compared to a gold standard, we believe the authors' conclusion may be overoptimistic and does not undoubtedly answer the primary outcome.

Point-of-care ultrasound in pregnancy: gastric, airway, neuraxial, cardiorespiratory.

PURPOSE OF REVIEW: This review focuses on the use of point-of-care ultrasound (PoCUS) in the obstetric context for airway management and assessment of aspiration risk, the placement of neuraxial blocks and the diagnosis and follow-up of cardiorespiratory dysfunction. RECENT FINDINGS: Gastric ultrasound is a useful aspiration risk assessment tool in pregnant patients. Total gastric fluid assessment models and specific cut-offs between high-risk and low-risk stomachs are presented. Airway assessment is useful to detect specific changes in pregnancy and to guide airway management. Handheld ultrasound devices with automated neuraxial landmark detection capabilities could facilitate needle placement in the future. Lung and cardiac ultrasonography is useful in the management of preeclampsia, pulmonary arterial hypertension and peripartum cardiomyopathy. SUMMARY: Owing to its noninvasiveness, ease of accessibility and lack of exposure to radiation, PoCUS plays an increasing and essential role in aspiration risk assessment, airway management, neuraxial anaesthesia and cardiorespiratory diagnosis and decision-making during pregnancy.