Effect of Resuscitation on Gastric Emptying Using POCUS in Pediatric Trauma Patients

Effect of Resuscitation on Gastric Emptying by Gastric Residual Volume Assessment Using Point of Care Ultrasonography in Pediatric Trauma Patients

Pediatric trauma often leads to hemorrhagic shock, which reduces blood flow to the digestive tract and delays gastric emptying. This delay can cause fluid and food to remain in the stomach, increasing the risk of pulmonary aspiration during urgent airway management or emergency anesthesia. Point-of-care ultrasound (POCUS) is a bedside, non-invasive tool that allows clinicians to evaluate stomach contents and estimate gastric volume in real time.

The primary purpose of this study is to evaluate whether restoring systemic blood flow through hemodynamic resuscitation improves gastric emptying and decreases gastric residual volume in injured children.

Participants aged 2 to 7 years presenting to the emergency department with trauma and hemorrhagic shock will receive standard resuscitation according to pediatric advanced life support guidelines. Bedside gastric ultrasound will be performed to measure the antral cross-sectional area and calculate gastric residual volume before resuscitation begins, immediately following initial resuscitation, and every 6 hours for up to 48 hours. Ultrasound procedures are observational and will not delay any standard trauma care or urgent surgical interventions.

Inclusion Criteria:

• Pediatric patients aged 2 to 7 years presenting with trauma.
• Presenting with hemorrhagic shock requiring hemodynamic resuscitation (diagnosed according to Advanced Paediatric Life Support [APLS] guidelines based on clinical and laboratory evidence of inadequate tissue perfusion secondary to acute blood loss, such as age-adjusted hypotension, tachycardia, prolonged capillary refill time > 2 seconds, weak peripheral pulses, altered mental status, elevated serum lactate, and/or increased base deficit).
• Hemodynamically stable enough to undergo point-of-care gastric ultrasound (POCUS) examination without delaying emergency medical management.

Exclusion Criteria:

• Known gastrointestinal diseases affecting gastric motility (e.g., gastric outlet obstruction, intestinal obstruction).
• History of prior upper gastrointestinal surgery.
• Significant abdominal injury that may affect gastric motility.
• Need for immediate emergency surgical intervention before completion of study baseline assessments.
• Inability to adequately perform gastric POCUS (e.g., extensive abdominal wounds, surgical emphysema, or poor acoustic window).
• Gastric decompression performed before the initial ultrasound assessment.
• Isolated head injury.