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ACC : Acute and Critical Care



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Original Article
The diagnostic accuracy of ultrasonography over manual aspiration for gastric reserve volume estimation in critically ill patients
Rahul Sharma, Ravi Kant Dogra, Jyoti Pathania, Arti Sharma
Acute Crit Care. 2023;38(1):134-141.   Published online February 22, 2023
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AbstractAbstract PDF
Although gastric reserve volume (GRV) is a surrogate marker of gastrointestinal dysfunction and feeding intolerance, there is ambiguity in its estimation due to problems associated with its measurement. Introduction of point-of-care ultrasound as a tool for anesthetists kindled interest in its use for GRV estimation. Methods: In this prospective observational study, we recruited 57 critically ill patients and analyzed 586 samples of GRV obtained by both ultrasonography (USG) and manual aspiration. Results: The analysis showed that USG-guided GRV was significantly correlated (r=0.788, P<0.001) and in positive agreement with manual aspiration based on Bland-Altman plot, with a mean difference of 8.50±14.84 (95% confidence interval, 7.389–9.798). The upper and lower limits of agreement were 37.7 and –20.5, respectively, within the ±1.96 standard deviation (P<0.001). The respective sensitivity and positive predictive value, specificity and negative predictive value, and area under the curve of USG for feeding intolerance were 66.67%, 98.15%, and 0.82%, with 96.49% diagnostic accuracy. Conclusions: Ultrasonographic estimation of GRV was positively, significantly correlated and in agreement with the manual aspiration method and estimated feeding intolerance earlier. Routine use of gastric USG could avoid clinical situations where feeding status is unclear and there is high risk of aspiration and could become a standard practice of critical care.
Case Report
Recurrent Aspiration Pneumonia due to Anterior Cervical Osteophyte
Jae Jun Lee, Ji Young Hong, Jun Han Jung, Jun Hyeok Yang, Jun-Young Sohn
Korean J Crit Care Med. 2017;32(1):74-78.   Published online February 28, 2017
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  • 2 Citations
AbstractAbstract PDF
A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.


Citations to this article as recorded by  
  • Diffuse idiopathic skeletal hyperostosis of the cervical spine causing dysphagia and airway obstruction: an updated systematic review
    Netanja I. Harlianto, Jonneke S. Kuperus, Firdaus A.A. Mohamed Hoesein, Pim A. de Jong, Jacob A. de Ru, F. Cumhur Öner, Jorrit-Jan Verlaan
    The Spine Journal.2022; 22(9): 1490.     CrossRef
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    International Journal of Surgery Case Reports.2022; 93: 106993.     CrossRef

ACC : Acute and Critical Care