Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.05.004
Brazilian Journal of Anesthesiology
Narrative Review

A way forward in pulmonary aspiration incidence reduction: ultrasound, mathematics, and worldwide data collection

Um caminho a seguir na redução da incidência de aspiração pulmonar: ultrassom, matemática e coleta de dados em todo o mundo

Marko Zdravkovic, Joana Berger-Estilita, Jozica Wagner Kovacec, Massimiliano Sorbello, Dusan Mekis

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Abstract

Aspiration of gastric contents during induction of general anesthesia remains a significant cause of mortality and morbidity in anesthesia. Recent data show that pulmonary aspiration still accounts for many cases with implications on mortality despite technical and technological evolution. Practical, ethical, and methodological issues prevent high-quality research in the setting of aspiration and rapid sequence induction/intubation, and significant controversy is ongoing. Patients’ position, drugs choice, dosing and timing, use of cricoid force, and a reliable risk assessment are widely debated with significant questions still unanswered. We focus our discussion on three approaches to promote a better understanding of rapid sequence induction/intubation and airway management decision-making. Firstly, we review how we can use qualitative and quantitative assessment of fasting status and gastric content with the point-of-care ultrasound as an integral part of preoperative evaluation and planning. Secondly, we propose using imaging-based mathematical models to study different patient positions and aspiration mechanisms, including identifying aspiration triggers. Thirdly, we promote the development of a global data collection system aiming to obtain precise epidemiological data. Therefore, we fill the gap between evidence-based medicine and experts’ opinion through easily accessible and diffused computer-based databases. A better understanding of aspiration epidemiology obtained through focused global data gathering systems, the widespread use of ultrasound-based prandial status evaluation, and development of advanced mathematical models might potentially guide safer airway management decision making in the 21st century.

Keywords

Respiratory Aspiration;  Respiratory Aspiration of Gastric Contents;  Airway management;  Ultrasonography;  Models, Theoretical

Resumo

A aspiração do conteúdo gástrico durante a indução da anestesia geral continua sendo uma causa significativa de mortalidade e morbidade na anestesia. Dados recentes mostram que a aspiração pulmonar ainda é responsável por muitos casos com implicações na mortalidade, apesar da evolução técnica e tecnológica. Questões práticas, éticas e metodológicas impedem pesquisas de alta qualidade no cenário de aspiração e indução/intubação de sequência rápida, e uma controvérsia significativa está em andamento. A posição dos pacientes, a escolha dos medicamentos, a dosagem e o tempo, o uso da força cricoide e uma avaliação de risco confiável são amplamente debatidos com questões importantes ainda sem resposta. Concentramos nossa discussão em três abordagens para promover uma melhor compreensão da tomada de decisões de indução/intubação de sequência rápida e gerenciamento das vias aéreas. Em primeiro lugar, revisamos como podemos usar a avaliação qualitativa e quantitativa do estado de jejum e do conteúdo gástrico com o ultrassom no local de atendimento como parte integrante da avaliação e planejamento pré-operatórios. Em segundo lugar, propomos o uso de modelos matemáticos baseados em imagens para estudar diferentes posições do paciente e mecanismos de aspiração, incluindo a identificação de gatilhos de aspiração. Em terceiro lugar, promovemos o desenvolvimento de um sistema global de coleta de dados com o objetivo de obter dados epidemiológicos precisos. Portanto, preenchemos a lacuna entre a medicina baseada em evidências e a opinião de especialistas por meio de bancos de dados baseados em computador facilmente acessíveis e difundidos. Uma melhor compreensão da epidemiologia da aspiração obtida por meio de sistemas de coleta de dados globais focados, o uso generalizado da avaliação da condição prandial baseada em ultrassom e o desenvolvimento de modelos matemáticos avançados podem potencialmente orientar a tomada de decisões mais seguras sobre o manejo das vias aéreas no século XXI.

Palavras-chave

Aspiração Respiratória; Aspiração Respiratória de Conteúdo Gástrico; Manejo de vias aéreas; Ultrassonografia; Modelos, Teóricos

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Submitted date:
01/29/2021

Accepted date:
05/08/2021

60cb66eaa9539563622dfa14 rba Articles
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