Clinical Research Directory

Gastric Assessment of Pediatric Patients Undergoing Surgery

The goal of this pilot prospective cohort study is to examine the reproducibility of gastric volume and emptying as measured by gastric ultrasound and its correlation to a gold-standard test for gastric emptying in the perioperative period in pediatric patients. The main questions it aims to answer are: * What is the reliability (inter-rater variability between expert and novice assessors, and intra-rater variability) of a) the gastric antral cross-sectional area (CSA) and b) gastric volume using the Perlas US qualitative grading assessment, measured by using an ultrasound device in pediatric patients undergoing general anesthesia for elective surgery? * What is the correlation between ultrasound assessment of gastric emptying by the antral-CSA and gastric emptying determined by the acetaminophen absorption test (AAT), the gold standard? The study will include two cohorts. Cohort assignment will be based on age and anesthesia induction plan. Subjects \>7yrs of age and expected to get an IV induction will be assigned to Cohort #1. Subjects \<7yrs of age and not expected to get an IV induction will be assigned to Cohort #2. * Cohort 1 will include abdominal ultrasound for gastric assessment AND the acetaminophen absorption test which includes administering enteral acetaminophen (tylenol) with 6 oz of water and drawing of blood samples through a peripheral intravenous line. * Cohort 2 will include subjects for whom a peripheral intravenous line placement is not part of routine pre-operative care. Procedures for Cohort 2 will include abdominal ultrasound only in the pre-op area (no tylenol). This cohort is included to examine the reliability of measurements across age groups.

Gastrointestinal Dysmotility on Aspiration Risk

The hypothesis of this study is that esophageal and gastric dysmotility increase the risk of developing aspiration-associated symptoms in children with neurologic impairment. The investigators are conducting a ten week cross over study comparing prucalopride to famotidine for the treatment of aspiration-associated symptoms.

Potential Biomarkers and Pathogenic Mechanism for Reflux Aspiration-induced Lung Injury.

There is limited research on aspiration pneumonia-induced ARDS (Acute Respiratory Distress Syndrome), and currently there is a lack of studies on corresponding biomarkers and pathogenic mechanisms. We hypothesize that pH and amylase in BAL (Bronchoalveolar Lavage) may serve as candidate biomarkers for inhalation-induced ARDS. Furthermore, we use EIT analysis to explore the pathological mechanisms of ARDS induced by AP and evaluate the clinical value of NO in improving hypoxemia.

Gastric POCUS for Airway Management in Patients Using Glucagon-like Peptide-1 Receptor Agonist

1\. Introduction Scheduled surgery requires patients to undergo a preoperative fasting period of at least 6 hours to ensure an empty stomach, significantly reducing the risk of perioperative aspiration pneumonia. However, certain medications and/or conditions have been described that can cause delayed gastric emptying, potentially placing patients at risk for aspiration; among these entities are diabetic gastroparesis and the use of GLP-1 analogs as a treatment for diabetes. Glucagon-like peptide-1 (GLP-1) is an intestinal hormone with beneficial effects on blood glucose control. It stimulates insulin release, reduces glucagon production, and decreases appetite, making it a therapeutic tool for the treatment of type 2 diabetes and obesity. GLP-1 receptor agonists have been approved by the FDA for these indications, and their use is continuously increasing. One of the primary side effects of GLP-1 agonists is delayed gastric emptying, which can lead to nausea, vomiting, and abdominal distension. Recent scientific literature has presented multiple reports demonstrating delayed gastric emptying associated with the use of GLP-1 agonists, including cases of pulmonary aspiration during anesthesia (despite adequate fasting periods). These findings underscore the necessity for anesthesiologists and perioperative physicians to be aware of the potential risks associated with these medications. It is suggested that these drugs be discontinued days prior to elective surgical procedures, depending on dosing frequency. It is essential to assess the presence of gastrointestinal symptoms, as they may indicate an increase in residual gastric content and heighten the risk of complications. As the use of GLP-1 agonists continues to expand, it is crucial to recognize and manage the risks associated with delayed gastric emptying in patients utilizing these agents. Further research is needed to establish more precise guidelines and mitigate the perioperative risks associated with these drugs.

FBS-ASaP: Fibrobronchoscopy in ASpiration Pneumonia in the Emergency Department

Non-Profit Prospective Observational Pilot Study The study will have an overall duration of 3 years, with patient enrollment starting after ethical committee approval. In this study, all patients with a diagnosis of aspiration pneumonia who require aspiration of secretions or ingesta in the Emergency Department will be considered. A registry will be created with the patients\&#39; data, noting the type of procedure performed: laryngotracheal aspiration with a probe or with fibrobronchoscopy. This observational registry pilot study aims to evaluate the utility and adverse events related to the use of aspiration via videobronchoscopy performed in the Emergency Department and to compare the clinical outcomes of patients undergoing bronchoscopy with those treated only with blind laryngotracheal aspiration using a probe.

Gastric US in ICU Patient

This is a case series study using gastric ultrasound in critically ill patients to quantify gastric residual volumes to compare the efficacy of different NPO protocols.