NPO Time Doesn’t Mean Empty Stomach – Another Pediatric POCUS Study

Written by Vivian Lei

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Most pediatric patients undergoing procedural sedation in this single-center ED study had “high risk” gastric content on ultrasound, even when meeting ASA fasting guidelines, with no clinically significant change occurring during serial sonographic evaluations.

Why does this matter?
Pediatric patients undergoing procedural sedation and analgesia (PSA) are often expected to be NPO to reduce risk of aspiration of gastric contents. This paper utilized point-of-care ultrasound (POCUS) to assess gastric contents in pediatric patients at the time of PSA and while awaiting PSA, assigning risk categories based on a previously established gastric volume cutoff of 1.25 ml/kg. But don’t worry, it is not the researchers’ intent to recommend gastric ultrasounds on all pediatric sedations. This study supports previous findings in which being NPO for an adequate length of time did not mean an empty stomach in pediatric patients.

An empty belly is not worth the wait. Just sedate.
This was a prospective study on the use of gastric POCUS in pediatric patients over 6 months undergoing PSA. Of the 93 patients (mean age of 6.5 years), 79% were classified as “high risk” based on presence of gastric solid content despite median fasting time of 6.25 hours. Of those defined to be fasting by ASA standards (>8 hours for solids, >2 hours for liquids), 68% were still determined to have “high risk” content. Repeat evaluations were performed on 17 patients who were anticipated to have at least 2 hours before PSA, and all remained high risk before and at the time of PSA. Fasting time was a weak to moderate predictor of risk category. No aspiration events occurred with any study patients.

This study shows that most patients undergoing pediatric PSA do so with “high risk” gastric contents despite meeting fasting guidelines and do not seem to have any increased risk of aspiration. Waiting a couple of hours prior to performing PSA based on NPO status is unlikely to change how full a pediatric patient’s stomach is. Plan for pediatric sedation based on individual patient risk factors, the urgency of the procedure, and sedative technique rather than when the child last ate.

Source
Point-of-Care Ultrasound to Assess Gastric Content in Pediatric Emergency Department Procedural Sedation Patients. Pediatr Emerg Care. 2020 Jul 29. doi: 10.1097/PEC.0000000000002198. Online ahead of print.

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