Interest of a Period of Fasting Before Extubation in Resuscitation Patients

Study Overview
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Brief Summary
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Orotracheal extubation in resuscitation is a situation in which there is an elevated risk of inhalation. In resuscitation, enteral nutrition that is administered in a continuous flow is likely to accumulate in the stomach. Gastric motility in resuscitation patients may be impaired for many reasons: Iatrogenic: Catecholamines, sedatives and opioids slow down the digestive system and decrease the tone of the lower esophageal sphincter Shock, polytrauma, sepsis, pain or discomfort, or mechanical ventilation again create an alteration in gastric emptying. Enteral nutrition is commonly discontinued to manage extubation, but it is not systematic. Discontinuation leads to a decrease in caloric intake. Gastric ultrasound is a minimally invasive, reliable and promising means of monitoring that allows the stomach to be visualized directly. Studies on healthy subjects and in anaesthesia have made it possible to validate ultrasound in the context of the study of gastric content using both quantitative (including measurement of the antral area) and qualitative criteria. Measurement of the antral area was also studied in resuscitation. Antral area and gastric volume are closely related, with a correlation coefficient ranging from 0.6 to 0.91. Identifying patients at risk of inhalation by ultrasound could allow individualized enteral nutrition management prior to extubation in the resuscitation unit, and thus optimize nutritional management. The objective of the study is to identify factors associated with greated antral area in patients hospitalized in the intensive care unit. The hypothesis is that continued enteral nutrition before extubation is associated with increased gastric volume as measured by ultrasound.

Official Title
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Interest of a Period of Fasting Before Extubation in Resuscitation Patients: a Prospective Observational Study

Conditions
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Extubation, Intensive Care

Intervention / Treatment
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* Other: gastric ultrasound


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Person or next of kin/designated representative has provided his or her non-opposition Patient in medical or surgical intensive care, admitted for an urgent medical or surgical reason and for whom extubation have been planned by the practitioner in charge of the patient Exclusion Criteria: Person subject to legal protection (guardianship, trusteeship) Person subject to a justice safeguard measure Pregnant, parturient or breastfeeding woman Minor Anechoic patient or patient without an exploitable ultrasound window History of gastric or esophageal surgery Limitation of Care (LOC) order

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| intensive care unit inpatient<br>Inpatient intubated resuscitation patient with a scheduled extubation | Other: gastric ultrasound<br>* gastric ultrasound for measurement of the antral area<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Surface of the antral area in mm² |  | pre-extubation | 
| Duration of enteral feeding interruption in hours |  | pre-extubation |