Clinical recognition of a potentially full stomach and use of point-of-care gastric ultrasound (POCUS) by anesthesiologists: a Belgian survey

Clinical recognition of a potentially full stomach and use of point-of-care gastric ultrasound (POCUS) by anesthesiologists: a Belgian survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical recognition of a potentially full stomach and use of point-of-care gastric ultrasound (POCUS) by anesthesiologists: a Belgian survey Adrien Maseri, Quentin Delhez, Anne-Sophie Dincq, Dominique Lacrosse This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3721487/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 Apr, 2024 Read the published version in BMC Medical Education → Version 1 posted 8 You are reading this latest preprint version Abstract Background: Pulmonary aspiration syndrome remains a noteworthy complication of general anesthesia, particularly in unfasted patients. Ensuring a high degree of certainty regarding gastric emptiness is strongly associated with a reduction in the likelihood of pulmonary aspiration. Gastric point-of-care ultrasound (POCUS) allows both qualitative and quantitative assessment of gastric contents. Methods: The survey, created and approved by two certified anesthesiologists trained to perform gastric POCUS, was distributed to Belgian certified anesthesiologists and trainees between April 2020 and June 2021. Participants were provided with a simulated clinical case of a patient at risk for gastric aspiration according to his medical history. The objective of this study was to assess the identification of clinical high-risk situations for gastric aspiration, the importance of the gastric POCUS criteria, the importance of understanding the technical and practical features of the procedure, and the potential impact of the procedure on the induction plan for general anesthesia. The survey utilized conditional branching to ensure unbiased responses to POCUS-related questions. The questionnaire included multiple-choice questions, quantitative variables, and 5-point Likert scales. Daniel's formula, corrected for a finite population, was used to calculate the margin of error. Results: The survey was completed by 323 anesthesiologists. Among them, only 20.8% (27) identified the risk of a full stomach based on the patient's history. Anesthesiologists who recognized the indication for gastric POCUS and were trained in the procedure demonstrated good recall of the practical conditions for performing the procedure and interpreting the results. Only 13.08% (31) of all respondents had received training in gastric POCUS, while 72.57% (172) expressed interest in future training. Additionally, 80.17% (190) of the participants had access to adequate ultrasound equipment, and 78.90% (187) endorsed teaching gastric POCUS to anesthesiology trainees. Conclusions: This survey provides insight into the epidemiology, clinical recognition, knowledge, and utilization of gastric POCUS among Belgian anesthesia professionals. The results highlight the importance of appropriate equipment and training to ensure the safe and effective implementation of gastric POCUS in anesthesia practice. Additional efforts should focus on enhancing training and encouraging the integration of gastric POCUS into daily clinical practice. Anesthesiology Gastrointestinal Contents/diagnostic Imaging Perioperative Care/Methods Pneumonia Aspiration/Prevention and Control Ultrasonography Figures Figure 1 Figure 2 Background First described in 1848 ( 1 ), pulmonary aspiration of gastric contents remains one of the most serious complications of general anesthesia ( 2 ), with a prevalence ranging from 1:3000 to 1:6000 in elective surgery and 1:600 in emergency surgery in adults ( 3 ). Additionally, it is linked to a mortality rate of up to 27.8% ( 4 ). Inhalational pneumonia occurs as a result of the inhalation of infectious substances or bacterial infection following regurgitation. The clinical presentation is similar to that of community-acquired pneumonia, but complications are prevalent. There is an increased incidence of cavitation or abscess. One significant risk factor is the presence of a significant amount of gastric residue. It can flow back into the upper airway due to bowel obstruction, failure to fast, medications for gastroparesis, or delayed gastric emptying ( 2 ). Thus, ensuring gastric emptying through sufficient fasting time to achieve an empty stomach is one of the most effective methods for preventing inhalation. However, this measure is reliable only for patients without risk factors for delayed gastric emptying, such as pregnancy, renal failure, diabetes, or opiate use. Another lesser known risk factor is chronic severe respiratory failure ( 5 – 7 ). Patients who are awaiting lung transplantation frequently have a high incidence of gastroparesis ( 5 ), which is unrelated to the underlying pulmonary ailment. The exact reason for this correlation remains unclear, but research on mice with cystic fibrosis indicates that it may be associated with damage to the migrating motor complex and dysfunction of the circular smooth muscles ( 8 ). Animal studies have shown that chronic hypoxemia in rats decreases the production of ghrelin ( 9 ), a hormone that stimulates gastric motility through the induction of phase III contractions. Autonomic dysregulation occurs due to chronic hypoxemia and the chronic use of β-mimetics ( 10 , 11 ), causing an increase in sympathetic tone and slower gastric emptying. Furthermore, chronic obstructive bronchopneumonia leads to the senescence of smooth muscle cells and an increase in the production of inflammatory mediators, such as prostaglandins ( 12 ). PGI2, a form of prostaglandin, slows gastric emptying, whereas prostaglandin E2 (PGE2) promotes this process. Nevertheless, inhibiting prostaglandin production in mice with cystic fibrosis led to normalization of gastric function, indicating that PGI2 may have a greater influence on gastroparesis ( 13 ). Since 1980, gastric ultrasound has been developed to provide a noninvasive assessment of gastric emptying( 14 ), particularly in patients with uncertain fasting compliance or risk factors. Teams led by Bouvet, Perlas, and Van de Putte ( 15 – 18 ) have refined their techniques for assessing gastric content and volume using the antral surface, culminating in the creation of a common technique known as gastric point-of-care ultrasound (gastric POCUS). This technique ( 19 ) allows for both qualitative (solid, liquid, or empty) and quantitative assessment of gastric filling status ( 20 ). To measure the cross-section of the antral surface, a 3.5-5 MHz curved ultrasound probe is used while the patient is in the supine position and then in the right lateral decubitus position for fluid analysis. The left lobe of the liver, pancreas, abdominal aorta, and superior mesenteric artery are used as anatomical landmarks for accurate measurement of this area. This area can be used to calculate the gastric residual volume based on patient age, with a recommended limit of less than 1.5 ml/kg ( 18 ). It is also possible to make a qualitative assessment using the Perlas grading system ( 21 ). This grading system allows classification into 3 categories: Grade 0 (the antrum is empty), Grade 1 (minimal fluid volume is detectable only in the right lateral decubitus position), and Grade 2 (the antrum is markedly distended, and fluid is visible in both the supine and lateral positions). The inclusion of gastric POCUS training in anesthesia residencies in other countries, such as Canada ( 22 ), prompts the inquiry of whether it should be incorporated into fundamental anesthesia residency training in Europe and Belgium. The aim of our study was to evaluate the ability of attending anesthesiologists and anesthesiology trainees in Belgium to identify risk factors pertaining to "full stomach" situations, including severe respiratory insufficiency, and to measure their awareness of the use of gastric ultrasound in such situations. Moreover, we aimed to assess the interest in training for anesthesiology providers in Belgium. Materials and methods Purpose/Aim The purpose of this study was to investigate various aspects, including the clinical recognition of high-risk situations related to a full stomach, awareness of the existence of gastric POCUS, understanding of the technical and practical aspects of the technique, and its potential impact on the induction plan. To address these areas, a survey with conditional branching was created, allowing participants to navigate to specific sections based on their previous responses. The questionnaire items and their corresponding conditional branches are presented in Table 1 for reference. Questionnaire and variables The study's target population included clinically active anesthesiologists in Belgium, consisting of 3023 certified anesthesiologists and 638 anesthesiology trainees, as reported by the National Institute for Health and Disability Insurance (NIHDI) ( 23 ). Participation in the survey was voluntary, and respondents did not receive any compensation. No criteria were used to exclude participants. By completing the questionnaire, participants consented to the analysis and use of their responses. The survey sample size was determined using the corrected Daniel formula for a finite population consisting of 3661 anesthesiologists in Belgium, with a confidence level of 95% and an acceptable margin of error of 0.05. A sample proportion of 0.50 was also considered, resulting in a formula-calculated requirement of 348 participants for the study. This study was conducted as a cross-sectional survey on a computer-based platform that included a total of 22 questions. The survey spanned seven pages and included several types of questions, including multiple-choice questions (MCQs), quantitative variable questions, and Likert scale questions. The text adhered to conventional academic structure and style guidelines, avoiding biased, emotional, or ornamental language and opting for clear, objective, and value-neutral language with passive tone and impersonal construction. The text maintained a formal register and avoided contractions, colloquial words, informal expressions, and unnecessary jargon. The structure was clear and progressive, and the writing was free from grammatical errors, spelling mistakes, and punctuation errors. Technical terms were consistently used, and technical term abbreviations were explained upon first usage. The survey was structured nonlinearly to enhance the accuracy of the data, requiring respondents to answer all the questions and prohibiting them from revisiting previous answers. Furthermore, conditional branching was employed in the survey design to ensure unbiased responses to technical ultrasound-related questions from participants unfamiliar with gastric point-of-care ultrasound. Table 1 presents a comprehensive diagram of the sequential process of the survey. [Placement of Table 1 - Questionnaire creation process based on clinical questions.] Table 1 Questionnaire creation process based on clinical questions. DIMENSIONS COMPONENTS QUESTIONS Epidemiology Q1 - Q5 Age, gender, level of training, type of practice Decoy Question Q6 How do you perform anesthesia for colonoscopy in your establishment? Clinical recognition of ‘at-risk’ situation Q7 - Q8 Actions to be taken if a "high risk" full stomach situation is suspected (e.g. gastric US, gastroscopy, CT scan, straightforward planning of rapid sequence induction). Do you have enough information to induce anesthesia? What is your plan to induce anesthesia? Decoy questions Q9 – Q11 What drugs will you use to induce anesthesia About the maintenance of anesthesia (Inhaled, Target controlled infusion) Where does the patient go after the colonoscopy? (recovery room, ICU, home) Knowledge of the existence of the technique Q12 Knowledge of the existence of the technique and its accessibility to the anesthesiologist In this situation, do you propose to proceed to Gastric-POCUS? Realization of the technique Q13 Knowledge of technical aspects What kind of US-probe do you use? Knowledge of patient positioning aspect In which position do you proceed to the examination? Knowledge of anatomical landmarks What are the necessary anatomical landmarks to obtain an interpretable image? Interpreting the results of Gastric POCUS Q14 - Q15 Qualitative analysis of the result Do you detect ‘at-risk’ gastric content? Qualitative analysis of the result Given the result of liquid volume evaluation, is the situation ‘at-risk’? Clinical decision according to the result Q16 – Q19 Clinical decision on anesthesia plan based on gastric content evaluation Do you delay the intervention? If it is not possible to reschedule the patient, how do you proceed with the induction of anesthesia? Field conditions for performing a Gastric-POCUS Q20 – Q22 State of training in Gastric POCUS Are you trained in performing Gastric-POCUS and, if not, do you want to? Availability of the correct US-probe Do you have a low-frequency US-probe available? Training of future specialists Should Gastric-POCUS be more present in basic anesthesiology training? The first set of questions (Q1-Q6) was designed to collect epidemiologic information such as sex, age, level of training, type of practice, and province of clinical practice. To assess participants' capacity to recognize situations with a high probability of a full stomach, the survey included question 7, which presented a clinical scenario of a patient undergoing a colonoscopy prior to lung transplantation [see Additional file 1]. Question 12 evaluated participants' interest in obtaining additional information about the case and their willingness to perform gastric POCUS while determining their training status. Trained participants then answered questions 13–15, which assessed the technical and anatomical requirements for performing gastric POCUS. The patients were presented with an explanatory diagram of gastric POCUS (Q16-Q19), which provided information on the ultrasound-derived measurements of gastric volume. The patients were then asked about their method of anesthesia induction. The survey concluded with questions about the accessibility of ultrasound equipment and respondents' opinions about the integration of POCUS training into the academic curriculum for anesthesia trainees. For detailed survey content, please refer to [Additional file 1]. The survey was pretested at the authors' institution; 11 responses were collected, with the primary objective of identifying potential problems with understanding the questionnaire. The sample included certified anesthesiologists, some of whom practiced exclusively in clinical settings, while others were also involved in academic research. Data collection The SurveyMonkey® survey was distributed electronically from April 2020 to June 2021 to active certified anesthesiologists and trainees working in hospitals throughout Belgium. A comprehensive list of surgical hospitals compiled by the FPS Public Health( 24 ) was used to target this specific group. A total of 117 anesthesia departments were contacted either through a contact form or direct mail to the anesthesia department secretary. To increase the reach and participation of the survey, it was made easily accessible on the authoritative websites of renowned professional associations, specifically the Belgian Society of Anesthesiology, Intensive Care, Perioperative Medicine and Pain Management and the Belgian Association for Regional Anesthesia. The survey sought to obtain a diverse and inclusive cohort of anesthesiologists from all regions of Belgium by taking advantage of these established digital platforms. The survey distribution email clearly stated that individuals who had previously completed the survey should not participate. This measure was taken to avoid duplicate responses from individuals who may have participated in previous distribution phases or received the survey through other channels. By prohibiting participants from taking the survey multiple times, the intent was to ensure the collection of distinct and unique responses from each participant. Statistical analysis Demographic characteristics, including age (years), sex (male/female), credential (certified/trainee), practice type (public/private/mixed) and region, were examined using descriptive statistics. Numerical variables are presented as the means and standard deviations, while categorical variables are presented as percentages. The same method was used to summarize categorical variables throughout the rest of the survey. The Likert scale, which measures respondents' level of agreement or disagreement, was weighted from 1 (strongly disagree) to 5 (strongly agree). The responses were averaged to calculate the overall level of agreement or disagreement, known for clarity as the weighted Likert score (WLS). For ease of understanding, numerical summaries were accompanied by graphical representations of the responses to the questions. The WLS method allows us to gain a broad understanding of agreements or disagreements among respondents. However, this approach does not provide a detailed analysis of individual responses. To provide a more comprehensive analysis, the graphical representation complements the numerical summary by providing a visual representation of the distribution of responses. No changes were made to the variables during the analysis. Results Participant flow A flowchart of the participant distribution across the survey section is shown in Fig. 1 . Figure 1 - Flowchart for participant distribution across survey sections Despite the expected sample size of 348, a total of 323 responses were received. Of these, 223 were certified anesthesiologists and 100 were anesthesia trainees. This allows us to calculate a final margin of error of 5.21%, which is used for all subsequent mean estimates. Of the 323 responses received, 170 participants selected direct induction of anesthesia. Of these, 158 continued the survey and indicated the type of induction used. One hundred and twelve participants were asked for additional information about the clinical case presented, and 111 answered the related questions. In this group, 22 patients had received training in gastric POCUS and answered specific questions related to the technique. At the end of the survey, 237 respondents were asked about equipment availability and interest in POCUS training. Descriptive results The final completion rate of the survey was 69%. The average time to complete the survey was 4 minutes and 39 seconds. To comply with the General Data Protection Regulation (GDPR) and to ensure anonymity, the computer system retained only the IP addresses of the participants. Pooling between responses and IP addresses did not reveal any matches. The reappearance of certain IP addresses could be related to the use of certain shared computers in different anesthesia departments. However, there is no guarantee that the same person did not respond twice on two different IP addresses. Main findings Question 1 to 5: Epidemiology The sociodemographic characteristics of the participants are described in Table 2 . Table 2 Sociodemographic of participants Certified Anesthesiologist (n = 223) Anesthesiology trainee (n = 100) Total (n = 323) Gender Male 133 59.64% 48 48.00% 181 56.04% Female 89 39.91% 50 50.00% 139 43.03% Other 1 0.45% 2 2.00% 3 0.93% Mean age (years ± SD) Total 45 ± 10 30 ± 6 40 ± 11 Type of practice University hospital 58 26.01% 67 67.00% 125 38.70% Public hospital 86 38.57% 19 19.00% 105 32.51% Private hospital 66 29.60% 9 9.00% 75 23.22% Mixed Practice 13 5.83% 5 5.00% 18 5.57% Question 7 for Clinical Recognition of “At-risk” Situation The clinical recognition of an “at-risk” situation is detailed in Table 3 . Table 3 Clinical recognition of “at-risk” situation Direct induction of anesthesia (n = 170) Needing more information (n = 113) Rapid sequence induction and intubation 21 13.29% Gastric POCUS 27 24.11% Other types of induction 137 86.71% Other Gastric evaluation 19 16.96% Other information needed 66 58.93% Discontinuation of survey 12 / Discontinuation of survey 1 0.89% Of the 323 responses received, 170 participants selected direct induction of anesthesia. Of these, 158 continued the survey and indicated the type of induction used. Rapid sequence induction and intubation (RSII) was selected for 13.29% (n = 21) of the patients. In addition, of the 112 participants who requested additional testing, 41.07% (n = 46) asked directly about gastric emptying, and 24.11% (n = 27) specifically requested gastric POCUS. It is important to note that 25.81% (n = 67) of the respondents were able to identify the possibility of a full stomach based on their medical history of respiratory insufficiency and current symptoms. Question 12: Knowledge of the indications for gastric POCUS Of the 111 participants who responded to the Q12 survey on fasting assessment, 85.6% (n = 95) recognized the indication for gastric ultrasound. Of these, 25.2% (n = 28) reported having received training in gastric ultrasound and specifically recognized the indication, while 60.4% (n = 67) reported recognizing the indication despite having no specific training in this area. Despite this, 14.4% (n = 16) of participants stated that gastric ultrasound was not necessary. Question 13: Realization of the technique The following results were obtained from the responses of the 22 trained participants. Our study used a WLS ranging from 1 to 5, and the results are shown in Fig. 2 . Figure 2 - Representation of Likert scale responses regarding the clinical context of performing gastric point-of-care ultrasound (POCUS) Technical aspects A mean WLS of 4.32 was observed for the use of the low-frequency curvilinear probe, indicating strong overall agreement with its use. In contrast, the high-frequency linear probe yielded a mean WLS of 1.71 and is perceived to have limited effectiveness in adult subjects. Patient positioning aspect Examination in the supine position followed by the right lateral decubitus position yielded a mean WLS of 4.27, suggesting strong overall agreement with this approach. The other positions showed strong overall disagreement, with a mean WLS of 1.82 for the dorsal position only and a mean WLS of 1.73 for the supine position followed by the left lateral decubitus position. Anatomical landmarks Using anatomic landmarks such as the left hepatic lobe, pancreas, abdominal aorta, and superior mesenteric artery to divide the gastric antrum resulted in a mean WLS of 4.41, demonstrating strong overall agreement with this approach. However, the use of anatomic landmarks such as the left hepatic lobe, pancreas, inferior vena cava, and left renal vein resulted in a mean WLS of 1.86, indicating overall robustness. Questions 14 and 15: Interpreting the Results of Gastric POCUS Qualitative analysis of the results When evaluating participants' ability to distinguish the gastric filling state, 63.64% (n = 14) of respondents indicated that the stomach was full based on the image provided with the question title. However, 31.82% (n = 7) of the participants were asked for additional information to accurately assess the filling state via measurement of the antral surface, while 4.6% (n = 1) of the participants stated that the stomach was empty. Among those who sought more information, 57.1% (n = 4) specifically requested an evaluation of the antral surface or the Perlas grading system. The participants were then informed of the amount of gastric fluid measured, which was 3.3 ml/kg, indicating a high-risk situation as it exceeded 1.5 ml/kg. Question 16 to 19: Clinical decision according to POCUS The majority of respondents were in favor of delaying the procedure until later in the day (mean WLS 3.91). However, they were less inclined to delay the procedure until the next day (mean WLS 2.30). If the procedure could not be postponed, 70.93% (n = 61) of the respondents opted for rapid RSII, while 11.63% (n = 10) opted for general anesthesia with endotracheal intubation without RSII. A total of 1.16% (n = 1) preferred the use of a laryngeal mask, and 16.7% (n = 14) performed procedural sedation despite the risk of inhalation. Questions 20 to 22: Field conditions for performing a gastric POCUS A total of 237 respondents answered the questions in this section, for a margin of error of 6.16%. The results are shown in Table 4 . Table 4 Field conditions for performing a Gastric-POCUS Certified Anesthesiologist (n = 172) Anesthesiology trainee (n = 65) Total (n = 237) State of training in Gastric POCUS Trained 26 15.12% 5 7.69% 31 13.08% Desire to be trained 117 68.02% 55 84.62% 172 72.57% Untrained and do not want to be 29 16.86% 5 7.69% 34 14.35% Availability of abdominal US probe Yes 139 80.81% 51 78.46% 190 80.17% No 24 13.95% 2 3.08% 26 10.97% Unknown 9 5.23% 12 18.46% 21 8.86% Gastric Point-of-care Ultrasound should be more present in basic anesthesiology training Yes 128 74.42% 59 90.77% 187 78.9% No 9 5.23% 1 1.54% 10 4.22% Neutral 35 20.35% 5 7.69% 40 16.88% State of training in gastric POCUS Among the respondents, 13.08% (n = 31) had been trained in gastric POCUS. Conversely, 72.57% (n = 172) of the respondents were not trained but would like to be trained, while 14.35% (n = 34) were not trained and did not want to be trained. Availability of the correct US probe Regarding the availability of the appropriate ultrasound probe, 80.17% (n = 190) of participants had access to a low-frequency curved ultrasound probe. However, 10.97% (n = 26) of participants did not have this probe, and 8.86% (n = 21) were unsure of its availability. Training of future specialists Regarding the training of future specialists, a majority of the 78.90% (n = 187) of respondents were in favor of teaching gastric POCUS to trainees, while only 4.22% (n = 10) were opposed and 16.88% (n = 40) were neutral. Discussion Limitations In Belgium, Dutch and French are the two predominant languages. To avoid potential translation errors, the authors opted for English; however, some practitioners may find its use discouraging, which could limit the response rate. Moreover, the number of survey dropouts may be explained by the potential length of the survey, despite mean completion times of 4 minutes and 39 seconds. There may be other potential influences to take into account, including the potential effect of frequent mailbox congestion on the visibility of the electronic survey or on participants' desire to engage. Nevertheless, employing professional email addresses and liaising with anesthesia departments can help to mitigate this possibility of distortion. Irrespective of the measures implemented at the outset of the study, it is not feasible to guarantee that no participant completed the survey twice. It is crucial to take into account the potential consequences of study dropouts, as they may lead to greater imprecision of responses as the questionnaire advances. The margin of error percentage had to be revised upward as the survey progressed. Additionally, inaccuracies could have been created because of survey question design and the inclusion of decoy questions to avoid response bias on our research topic. Interpretations Clinical recognition of a "high risk" situation for the full stomach In 20.8% of individuals, the possibility of a full stomach risk situation was suspected, either through the performance of an RSII or by specifically requesting a gastric emptying assessment. Knowledge of clinical risk factors such as severe respiratory insufficiency, independently known to be a factor for delayed gastric emptying, must be taken into account, and clinicians should be alerted to the risk of delayed gastric emptying. Indications, technical aspects and interpretations of gastric POCUS A vast majority of respondents who suspected delayed gastric emptying acknowledged the necessity of gastric POCUS in our clinical setting. Nonetheless, only 13.1% of the respondents had been previously trained in the technique. For these trained individuals, the technical standards for performing gastric POCUS were well understood, with unanimous agreement on the use of a low-frequency curved ultrasound probe and the supine position followed by lateral testing. The respondents' mastery of the needed anatomical landmarks for executing the technique also proved to be highly adequate. Almost all participants could detect the presence of fluid in the stomach while interpreting the ultrasound image. Furthermore, approximately one-third of the respondents requested that the antral cross-sectional area be measured as a next step to determine whether the present fluid was abnormal. A significant portion of participants reported abnormal fluid volume based on images without measurements, which may be related to the large amount of fluid present in the image. In experienced echographers, this might result in an approximation of the filling status. It was generally agreed that the procedure should be postponed until later in the day but not until the following day. Faced with the necessity of proceeding without delay, most of the respondents with gastric ultrasound training either performed RSII or were administered general anesthesia with intubation. Despite the disclosure of a volume of gastric fluid that exceeded the high-risk threshold by more than twofold, 17% of the respondents still dispensed procedural sedation without securing the airway. Environmental conditions for performing a gastric POCUS State of training in gastric POCUS Few respondents were actually trained to perform gastric POCUS, but the demand for training was high, especially among trainees. Most users have access to the needed ultrasound equipment. Furthermore, there is significant interest in teaching this technique to future anesthesiology trainees. These findings underline the clinical benefit of this technique in cases of uncertainty about gastric filling status. Generalizability This study's sample size is restricted to the Belgian population because they have a distinct anesthesia training system compared to that of other neighboring countries. The variation in regulations and anesthesia practices also limits the generalizability of the outcomes to other national contexts. Consequently, identifying these differences is critical when interpreting the results. Further research is vital in every country to obtain data reflecting the specific population of each country. Conclusions Clinical recognition of a full stomach is insufficient among the general population of anesthesiologists in Belgium. Although gastric POCUS has a well-established indication for patients who are at risk for a full stomach, the proportion of trained practitioners is relatively low. Training in the gastric POCUS technique leads to a comprehensive understanding of the indications, ergonomics and ultrasound conditions. The qualitative identification of high-risk gastric contents using ultrasound has been proven effective. However, there is still a lack of complete understanding of the quantitative definition. The results of our survey indicate that a significant majority of Belgian practitioners who do not have training in gastric POCUS express a strong desire to receive such training and support its integration into the basic training program for Belgian physician assistants. Incorporating point-of-care ultrasound techniques, particularly for evaluating gastric emptying, into the education of future anesthesiologists is a practical and efficient approach to mitigate complications related to anesthesia. Abbreviations NIHDI National Institute for Health and Disability Insurance POCUS Point-of-care ultrasound RSII rapid sequence induction and intubation WLS weighted Likert scale Declarations Ethics approval and consent to participate The content of the survey was submitted to and approved by the Comité d'éthique du CHU UCL Namur, site Godinne. The Ethics Committee (NUB reference number: B0392022000065) considered that answering the survey was equivalent to implicit consent. The survey prioritized confidentiality and data privacy by excluding questions or variables that could directly identify participants. Personalized or identifying information was not utilized during the distribution of the survey. Electronic communication via email or contact forms was utilized to disseminate the survey to anesthesiologists in Belgian hospitals. The survey was distributed by scientific societies that utilized their own distribution lists, which could not be accessed by the authors. The data were collected through the secure web link provided by SurveyMonkey®, which retained only participants' IP addresses; these data were deleted after 13 months. Momentive™, the parent company of SurveyMonkey®, offers a Data Processing Agreement (DPA) compliant with the European Union General Data Protection Regulations and EU and UK standard contractual clauses. The Momentive™ Customer Data Processing Agreement was accessed at the following link: [https://fr.surveymonkey.com/mp/legal/data-processing-agreement/]. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding The SurveyMonkey® subscription was paid for by Dr. Adrien Maseri's personal funds. No other source of funding is reported. Authors' contributions A.M., D.L. and AS.D. wrote the main manuscript text, and A.M. prepared Figures 1-2 and Table 1. A.M. and D.L. designed the survey content and distributed the survey. A.M., D.L., AS.D. and Q.D., have drafted the work or substantively revised it. All the authors reviewed and approved the submitted version. Acknowledgments The authors of the study received rigorous training in conducting gastric point-of-care ultrasound (POCUS) under the supervision of Professor Peter Van de Putte (Imeldaziekenhuis Bonheiden, Belgium), a specialist in this technique. The training covered both theoretical and practical aspects and was completed at CHU UCL Namur. To maintain regular education, the authors regularly practiced Gastric POCUS and sought updated information and resources from the website of Gastricultrasound.org (19). This manuscript adheres to the CROSS Guidelines (25) (Checklist for Reporting of Survey Studies) of the Equator Network. References Simpson J. 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Ultrasound assessment of gastric content and volume. Br J Anaesth. 2014;113(1):12–22. Putte PVd, Bouvet L, Kruisselbrin R, Spencer A, Arzola C. A Point-of-care tool for aspiration risk assessment 2019 [Gastricultrasound.org is a free web-based educational resource that contains information related to the performance and interpretation of point-of-care perioperative gastric ultrasound for aspiration risk assessment, based on peer-reviewed data and the opinion of the editors]. Available from: https://www.gastricultrasound.org/en/home/ . Mackenzie DC, Azad AM, Noble VE, Liteplo AS. Test performance of point-of-care ultrasound for gastric content. Am J Emerg Med. 2019;37(1):123–6. Perlas A, Davis L, Khan M, Mitsakakis N, Chan VW. Gastric sonography in the fasted surgical patient: a prospective descriptive study. Anesth Analg. 2011;113(1):93–7. Meineri M, Arellano R, Bryson G, Arzola C, Chen R, Collins P, et al. Canadian recommendations for training and performance in basic perioperative point-of-care ultrasound: recommendations from a consensus of Canadian anesthesiology academic centres. Can J Anaesth = J canadien d'anesthesie. 2021;68(3):376–86. Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, et al. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Annals of oncology: official journal of the European Society for Medical Oncology. 2018;29(Suppl 4):iv166–iv91. Service Public Fédéral Santé publique SdlcaeEIdsSSP. Contacts et données d'agrément des hôpitaux généraux et psychiatriques 2021 [Available from: https://www.health.belgium.be/fr/sante/organisation-des-soins-de-sante/partage-de-donnees-de-sante/institutions-de-soins . Sharma A, Minh Duc NT, Luu Lam Thang T, Nam NH, Ng SJ, Abbas KS, et al. A Consensus-Based Checklist for Reporting of Survey Studies (CROSS). J Gen Intern Med. 2021;36(10):3179–87. Additional Declarations No competing interests reported. Supplementary Files Additionalfile1.pdf Cite Share Download PDF Status: Published Journal Publication published 08 Apr, 2024 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 07 Feb, 2024 Reviews received at journal 19 Jan, 2024 Reviewers agreed at journal 19 Jan, 2024 Reviewers invited by journal 18 Jan, 2024 Editor assigned by journal 18 Jan, 2024 Editor invited by journal 31 Dec, 2023 Submission checks completed at journal 31 Dec, 2023 First submitted to journal 07 Dec, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3721487","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":264542458,"identity":"773ffcbe-ec7c-4750-827a-3282972eb051","order_by":0,"name":"Adrien Maseri","email":"data:image/png;base64,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","orcid":"","institution":"CHU Dinant Godinne UCL Namur","correspondingAuthor":true,"prefix":"","firstName":"Adrien","middleName":"","lastName":"Maseri","suffix":""},{"id":264542459,"identity":"bfc2efe1-e4a6-4163-a146-00aa8dcc6fb6","order_by":1,"name":"Quentin Delhez","email":"","orcid":"","institution":"CHU Dinant Godinne UCL Namur","correspondingAuthor":false,"prefix":"","firstName":"Quentin","middleName":"","lastName":"Delhez","suffix":""},{"id":264542460,"identity":"158ad096-e454-4d39-8338-fe14c72c472b","order_by":2,"name":"Anne-Sophie Dincq","email":"","orcid":"","institution":"CHU Dinant Godinne UCL Namur","correspondingAuthor":false,"prefix":"","firstName":"Anne-Sophie","middleName":"","lastName":"Dincq","suffix":""},{"id":264542461,"identity":"b79acf04-330f-4944-bf5a-17aeb7816faa","order_by":3,"name":"Dominique Lacrosse","email":"","orcid":"","institution":"CHU Dinant Godinne UCL Namur","correspondingAuthor":false,"prefix":"","firstName":"Dominique","middleName":"","lastName":"Lacrosse","suffix":""}],"badges":[],"createdAt":"2023-12-07 16:29:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3721487/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3721487/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-024-05359-5","type":"published","date":"2024-04-08T15:00:58+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":49129107,"identity":"83f54d0f-8c88-4cc5-a84c-db07e8ec9280","added_by":"auto","created_at":"2024-01-03 15:13:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":29470,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart for participant distribution across survey sections\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-3721487/v1/83e467223f628f9bfcadbf3b.png"},{"id":49129108,"identity":"9052bced-dc4e-4583-81f1-173d029fdbb0","added_by":"auto","created_at":"2024-01-03 15:13:12","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":24356,"visible":true,"origin":"","legend":"\u003cp\u003eRepresentation of Likert scale responses regarding the clinical context of performing gastric point-of-care ultrasound (POCUS)\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-3721487/v1/8884a55348d681b8ba86e428.png"},{"id":54712856,"identity":"5b046fe8-d92c-4863-932b-d4ce9823d5f5","added_by":"auto","created_at":"2024-04-15 15:13:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":696280,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3721487/v1/c69d18e7-84b1-4793-9341-38a8dd6c5bdc.pdf"},{"id":49129109,"identity":"3a8ab149-5306-4bf7-9b3f-cc10442785d2","added_by":"auto","created_at":"2024-01-03 15:13:12","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":226029,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3721487/v1/88707a29e614a968620310d9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical recognition of a potentially full stomach and use of point-of-care gastric ultrasound (POCUS) by anesthesiologists: a Belgian survey","fulltext":[{"header":"Background","content":"\u003cp\u003eFirst described in 1848 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), pulmonary aspiration of gastric contents remains one of the most serious complications of general anesthesia (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), with a prevalence ranging from 1:3000 to 1:6000 in elective surgery and 1:600 in emergency surgery in adults (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Additionally, it is linked to a mortality rate of up to 27.8% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInhalational pneumonia occurs as a result of the inhalation of infectious substances or bacterial infection following regurgitation. The clinical presentation is similar to that of community-acquired pneumonia, but complications are prevalent. There is an increased incidence of cavitation or abscess. One significant risk factor is the presence of a significant amount of gastric residue. It can flow back into the upper airway due to bowel obstruction, failure to fast, medications for gastroparesis, or delayed gastric emptying (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Thus, ensuring gastric emptying through sufficient fasting time to achieve an empty stomach is one of the most effective methods for preventing inhalation. However, this measure is reliable only for patients without risk factors for delayed gastric emptying, such as pregnancy, renal failure, diabetes, or opiate use.\u003c/p\u003e \u003cp\u003eAnother lesser known risk factor is chronic severe respiratory failure (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Patients who are awaiting lung transplantation frequently have a high incidence of gastroparesis (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), which is unrelated to the underlying pulmonary ailment. The exact reason for this correlation remains unclear, but research on mice with cystic fibrosis indicates that it may be associated with damage to the migrating motor complex and dysfunction of the circular smooth muscles (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Animal studies have shown that chronic hypoxemia in rats decreases the production of ghrelin (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), a hormone that stimulates gastric motility through the induction of phase III contractions. Autonomic dysregulation occurs due to chronic hypoxemia and the chronic use of β-mimetics (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), causing an increase in sympathetic tone and slower gastric emptying. Furthermore, chronic obstructive bronchopneumonia leads to the senescence of smooth muscle cells and an increase in the production of inflammatory mediators, such as prostaglandins (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). PGI2, a form of prostaglandin, slows gastric emptying, whereas prostaglandin E2 (PGE2) promotes this process. Nevertheless, inhibiting prostaglandin production in mice with cystic fibrosis led to normalization of gastric function, indicating that PGI2 may have a greater influence on gastroparesis (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSince 1980, gastric ultrasound has been developed to provide a noninvasive assessment of gastric emptying(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), particularly in patients with uncertain fasting compliance or risk factors. Teams led by Bouvet, Perlas, and Van de Putte (\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) have refined their techniques for assessing gastric content and volume using the antral surface, culminating in the creation of a common technique known as gastric point-of-care ultrasound (gastric POCUS).\u003c/p\u003e \u003cp\u003eThis technique (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) allows for both qualitative (solid, liquid, or empty) and quantitative assessment of gastric filling status (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). To measure the cross-section of the antral surface, a 3.5-5 MHz curved ultrasound probe is used while the patient is in the supine position and then in the right lateral decubitus position for fluid analysis. The left lobe of the liver, pancreas, abdominal aorta, and superior mesenteric artery are used as anatomical landmarks for accurate measurement of this area. This area can be used to calculate the gastric residual volume based on patient age, with a recommended limit of less than 1.5 ml/kg (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt is also possible to make a qualitative assessment using the Perlas grading system (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). This grading system allows classification into 3 categories: Grade 0 (the antrum is empty), Grade 1 (minimal fluid volume is detectable only in the right lateral decubitus position), and Grade 2 (the antrum is markedly distended, and fluid is visible in both the supine and lateral positions).\u003c/p\u003e \u003cp\u003eThe inclusion of gastric POCUS training in anesthesia residencies in other countries, such as Canada (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), prompts the inquiry of whether it should be incorporated into fundamental anesthesia residency training in Europe and Belgium.\u003c/p\u003e \u003cp\u003eThe aim of our study was to evaluate the ability of attending anesthesiologists and anesthesiology trainees in Belgium to identify risk factors pertaining to \"full stomach\" situations, including severe respiratory insufficiency, and to measure their awareness of the use of gastric ultrasound in such situations. Moreover, we aimed to assess the interest in training for anesthesiology providers in Belgium.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePurpose/Aim\u003c/h2\u003e \u003cp\u003eThe purpose of this study was to investigate various aspects, including the clinical recognition of high-risk situations related to a full stomach, awareness of the existence of gastric POCUS, understanding of the technical and practical aspects of the technique, and its potential impact on the induction plan. To address these areas, a survey with conditional branching was created, allowing participants to navigate to specific sections based on their previous responses. The questionnaire items and their corresponding conditional branches are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for reference.\u003c/p\u003e\u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eQuestionnaire and variables\u003c/h2\u003e \u003cp\u003eThe study's target population included clinically active anesthesiologists in Belgium, consisting of 3023 certified anesthesiologists and 638 anesthesiology trainees, as reported by the National Institute for Health and Disability Insurance (NIHDI) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Participation in the survey was voluntary, and respondents did not receive any compensation. No criteria were used to exclude participants. By completing the questionnaire, participants consented to the analysis and use of their responses.\u003c/p\u003e \u003cp\u003eThe survey sample size was determined using the corrected Daniel formula for a finite population consisting of 3661 anesthesiologists in Belgium, with a confidence level of 95% and an acceptable margin of error of 0.05. A sample proportion of 0.50 was also considered, resulting in a formula-calculated requirement of 348 participants for the study.\u003c/p\u003e \u003cp\u003eThis study was conducted as a cross-sectional survey on a computer-based platform that included a total of 22 questions. The survey spanned seven pages and included several types of questions, including multiple-choice questions (MCQs), quantitative variable questions, and Likert scale questions. The text adhered to conventional academic structure and style guidelines, avoiding biased, emotional, or ornamental language and opting for clear, objective, and value-neutral language with passive tone and impersonal construction. The text maintained a formal register and avoided contractions, colloquial words, informal expressions, and unnecessary jargon. The structure was clear and progressive, and the writing was free from grammatical errors, spelling mistakes, and punctuation errors. Technical terms were consistently used, and technical term abbreviations were explained upon first usage. The survey was structured nonlinearly to enhance the accuracy of the data, requiring respondents to answer all the questions and prohibiting them from revisiting previous answers. Furthermore, conditional branching was employed in the survey design to ensure unbiased responses to technical ultrasound-related questions from participants unfamiliar with gastric point-of-care ultrasound. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents a comprehensive diagram of the sequential process of the survey.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e[Placement of Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e - Questionnaire creation process based on clinical questions.]\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuestionnaire creation process based on clinical questions.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDIMENSIONS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCOMPONENTS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQUESTIONS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEpidemiology\u003c/p\u003e \u003cp\u003eQ1 - Q5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAge, gender, level of training, type of practice\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecoy Question\u003c/p\u003e \u003cp\u003eQ6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHow do you perform anesthesia for colonoscopy in your establishment?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eClinical recognition of \u0026lsquo;at-risk\u0026rsquo; situation\u003c/p\u003e \u003cp\u003eQ7 - Q8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eActions to be taken if a \"high risk\" full stomach situation is suspected (e.g. gastric US, gastroscopy, CT scan, straightforward planning of rapid sequence induction).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDo you have enough information to induce anesthesia?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhat is your plan to induce anesthesia?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecoy questions\u003c/p\u003e \u003cp\u003eQ9 \u0026ndash; Q11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eWhat drugs will you use to induce anesthesia\u003c/p\u003e \u003cp\u003eAbout the maintenance of anesthesia (Inhaled, Target controlled infusion)\u003c/p\u003e \u003cp\u003eWhere does the patient go after the colonoscopy? (recovery room, ICU, home)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge of the existence of the technique\u003c/p\u003e \u003cp\u003eQ12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKnowledge of the existence of the technique and its accessibility to the anesthesiologist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn this situation, do you propose to proceed to Gastric-POCUS?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eRealization of the technique\u003c/p\u003e \u003cp\u003eQ13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKnowledge of technical aspects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhat kind of US-probe do you use?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKnowledge of patient positioning aspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn which position do you proceed to the examination?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKnowledge of anatomical landmarks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhat are the necessary anatomical landmarks to obtain an interpretable image?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInterpreting the results of Gastric POCUS\u003c/p\u003e \u003cp\u003eQ14 - Q15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQualitative analysis of the result\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDo you detect \u0026lsquo;at-risk\u0026rsquo; gastric content?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQualitative analysis of the result\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGiven the result of liquid volume evaluation, is the situation \u0026lsquo;at-risk\u0026rsquo;?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eClinical decision according to the result\u003c/p\u003e \u003cp\u003eQ16 \u0026ndash; Q19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eClinical decision on anesthesia plan based on gastric content evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDo you delay the intervention?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIf it is not possible to reschedule the patient, how do you proceed with the induction of anesthesia?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eField conditions for performing a Gastric-POCUS\u003c/p\u003e \u003cp\u003eQ20 \u0026ndash; Q22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eState of training in Gastric POCUS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAre you trained in performing Gastric-POCUS and, if not, do you want to?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAvailability of the correct US-probe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDo you have a low-frequency US-probe available?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraining of future specialists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eShould Gastric-POCUS be more present in basic anesthesiology training?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe first set of questions (Q1-Q6) was designed to collect epidemiologic information such as sex, age, level of training, type of practice, and province of clinical practice. To assess participants' capacity to recognize situations with a high probability of a full stomach, the survey included question 7, which presented a clinical scenario of a patient undergoing a colonoscopy prior to lung transplantation [see Additional file 1]. Question 12 evaluated participants' interest in obtaining additional information about the case and their willingness to perform gastric POCUS while determining their training status. Trained participants then answered questions 13\u0026ndash;15, which assessed the technical and anatomical requirements for performing gastric POCUS.\u003c/p\u003e \u003cp\u003eThe patients were presented with an explanatory diagram of gastric POCUS (Q16-Q19), which provided information on the ultrasound-derived measurements of gastric volume. The patients were then asked about their method of anesthesia induction.\u003c/p\u003e \u003cp\u003eThe survey concluded with questions about the accessibility of ultrasound equipment and respondents' opinions about the integration of POCUS training into the academic curriculum for anesthesia trainees. For detailed survey content, please refer to [Additional file 1].\u003c/p\u003e \u003cp\u003eThe survey was pretested at the authors' institution; 11 responses were collected, with the primary objective of identifying potential problems with understanding the questionnaire. The sample included certified anesthesiologists, some of whom practiced exclusively in clinical settings, while others were also involved in academic research.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eThe SurveyMonkey\u0026reg; survey was distributed electronically from April 2020 to June 2021 to active certified anesthesiologists and trainees working in hospitals throughout Belgium. A comprehensive list of surgical hospitals compiled by the FPS Public Health(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) was used to target this specific group. A total of 117 anesthesia departments were contacted either through a contact form or direct mail to the anesthesia department secretary.\u003c/p\u003e \u003cp\u003eTo increase the reach and participation of the survey, it was made easily accessible on the authoritative websites of renowned professional associations, specifically the Belgian Society of Anesthesiology, Intensive Care, Perioperative Medicine and Pain Management and the Belgian Association for Regional Anesthesia. The survey sought to obtain a diverse and inclusive cohort of anesthesiologists from all regions of Belgium by taking advantage of these established digital platforms.\u003c/p\u003e \u003cp\u003eThe survey distribution email clearly stated that individuals who had previously completed the survey should not participate. This measure was taken to avoid duplicate responses from individuals who may have participated in previous distribution phases or received the survey through other channels. By prohibiting participants from taking the survey multiple times, the intent was to ensure the collection of distinct and unique responses from each participant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDemographic characteristics, including age (years), sex (male/female), credential (certified/trainee), practice type (public/private/mixed) and region, were examined using descriptive statistics. Numerical variables are presented as the means and standard deviations, while categorical variables are presented as percentages. The same method was used to summarize categorical variables throughout the rest of the survey.\u003c/p\u003e \u003cp\u003eThe Likert scale, which measures respondents' level of agreement or disagreement, was weighted from 1 (strongly disagree) to 5 (strongly agree). The responses were averaged to calculate the overall level of agreement or disagreement, known for clarity as the weighted Likert score (WLS). For ease of understanding, numerical summaries were accompanied by graphical representations of the responses to the questions.\u003c/p\u003e \u003cp\u003eThe WLS method allows us to gain a broad understanding of agreements or disagreements among respondents. However, this approach does not provide a detailed analysis of individual responses. To provide a more comprehensive analysis, the graphical representation complements the numerical summary by providing a visual representation of the distribution of responses. No changes were made to the variables during the analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eParticipant flow\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eA flowchart of the participant distribution across the survey section is shown in\u003c/span\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cb\u003e- Flowchart for participant distribution across survey sections\u003c/b\u003e\u003c/p\u003e \u003cp\u003eDespite the expected sample size of 348, a total of 323 responses were received. Of these, 223 were certified anesthesiologists and 100 were anesthesia trainees. This allows us to calculate a final margin of error of 5.21%, which is used for all subsequent mean estimates.\u003c/p\u003e \u003cp\u003eOf the 323 responses received, 170 participants selected direct induction of anesthesia. Of these, 158 continued the survey and indicated the type of induction used. One hundred and twelve participants were asked for additional information about the clinical case presented, and 111 answered the related questions. In this group, 22 patients had received training in gastric POCUS and answered specific questions related to the technique. At the end of the survey, 237 respondents were asked about equipment availability and interest in POCUS training.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eDescriptive results\u003c/h2\u003e \u003cp\u003eThe final completion rate of the survey was 69%. The average time to complete the survey was 4 minutes and 39 seconds. To comply with the General Data Protection Regulation (GDPR) and to ensure anonymity, the computer system retained only the IP addresses of the participants. Pooling between responses and IP addresses did not reveal any matches. The reappearance of certain IP addresses could be related to the use of certain shared computers in different anesthesia departments. However, there is no guarantee that the same person did not respond twice on two different IP addresses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eMain findings\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003eQuestion 1 to 5: Epidemiology\u003c/h2\u003e \u003cp\u003eThe sociodemographic characteristics of the participants are described in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCertified Anesthesiologist\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;223)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eAnesthesiology trainee\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;323)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.64%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e56.04%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.91%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e43.03%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.45%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.93%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eMean age (years\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e45\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e30\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e40\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eType of practice\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.01%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e38.70%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.57%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e32.51%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.22%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed Practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.83%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.57%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eQuestion 7 for Clinical Recognition of \u0026ldquo;At-risk\u0026rdquo; Situation\u003c/h2\u003e \u003cp\u003eThe clinical recognition of an \u0026ldquo;at-risk\u0026rdquo; situation is detailed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical recognition of \u0026ldquo;at-risk\u0026rdquo; situation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDirect induction of anesthesia\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;170)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eNeeding more information\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;113)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRapid sequence induction and intubation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGastric POCUS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e24.11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOther types of induction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e86.71%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOther Gastric evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e16.96%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOther information needed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e58.93%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiscontinuation of survey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDiscontinuation of survey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.89%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOf the 323 responses received, 170 participants selected direct induction of anesthesia. Of these, 158 continued the survey and indicated the type of induction used. Rapid sequence induction and intubation (RSII) was selected for 13.29% (n\u0026thinsp;=\u0026thinsp;21) of the patients. In addition, of the 112 participants who requested additional testing, 41.07% (n\u0026thinsp;=\u0026thinsp;46) asked directly about gastric emptying, and 24.11% (n\u0026thinsp;=\u0026thinsp;27) specifically requested gastric POCUS. It is important to note that 25.81% (n\u0026thinsp;=\u0026thinsp;67) of the respondents were able to identify the possibility of a full stomach based on their medical history of respiratory insufficiency and current symptoms.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eQuestion 12: Knowledge of the indications for gastric POCUS\u003c/h2\u003e \u003cp\u003e Of the 111 participants who responded to the Q12 survey on fasting assessment, 85.6% (n\u0026thinsp;=\u0026thinsp;95) recognized the indication for gastric ultrasound. Of these, 25.2% (n\u0026thinsp;=\u0026thinsp;28) reported having received training in gastric ultrasound and specifically recognized the indication, while 60.4% (n\u0026thinsp;=\u0026thinsp;67) reported recognizing the indication despite having no specific training in this area. Despite this, 14.4% (n\u0026thinsp;=\u0026thinsp;16) of participants stated that gastric ultrasound was not necessary.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eQuestion 13: Realization of the technique\u003c/h2\u003e \u003cp\u003eThe following results were obtained from the responses of the 22 trained participants. Our study used a WLS ranging from 1 to 5, and the results are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cb\u003e- Representation of Likert scale responses regarding the clinical context of performing gastric point-of-care ultrasound (POCUS)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eTechnical aspects\u003c/h2\u003e \u003cp\u003eA mean WLS of 4.32 was observed for the use of the low-frequency curvilinear probe, indicating strong overall agreement with its use. In contrast, the high-frequency linear probe yielded a mean WLS of 1.71 and is perceived to have limited effectiveness in adult subjects.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003ePatient positioning aspect\u003c/h2\u003e \u003cp\u003eExamination in the supine position followed by the right lateral decubitus position yielded a mean WLS of 4.27, suggesting strong overall agreement with this approach. The other positions showed strong overall disagreement, with a mean WLS of 1.82 for the dorsal position only and a mean WLS of 1.73 for the supine position followed by the left lateral decubitus position.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eAnatomical landmarks\u003c/h2\u003e \u003cp\u003eUsing anatomic landmarks such as the left hepatic lobe, pancreas, abdominal aorta, and superior mesenteric artery to divide the gastric antrum resulted in a mean WLS of 4.41, demonstrating strong overall agreement with this approach. However, the use of anatomic landmarks such as the left hepatic lobe, pancreas, inferior vena cava, and left renal vein resulted in a mean WLS of 1.86, indicating overall robustness.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eQuestions 14 and 15: Interpreting the Results of Gastric POCUS\u003c/h2\u003e \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e \u003ch2\u003eQualitative analysis of the results\u003c/h2\u003e \u003cp\u003eWhen evaluating participants' ability to distinguish the gastric filling state, 63.64% (n\u0026thinsp;=\u0026thinsp;14) of respondents indicated that the stomach was full based on the image provided with the question title. However, 31.82% (n\u0026thinsp;=\u0026thinsp;7) of the participants were asked for additional information to accurately assess the filling state via measurement of the antral surface, while 4.6% (n\u0026thinsp;=\u0026thinsp;1) of the participants stated that the stomach was empty. Among those who sought more information, 57.1% (n\u0026thinsp;=\u0026thinsp;4) specifically requested an evaluation of the antral surface or the Perlas grading system. The participants were then informed of the amount of gastric fluid measured, which was 3.3 ml/kg, indicating a high-risk situation as it exceeded 1.5 ml/kg.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eQuestion 16 to 19: Clinical decision according to POCUS\u003c/h2\u003e \u003cp\u003eThe majority of respondents were in favor of delaying the procedure until later in the day (mean WLS 3.91). However, they were less inclined to delay the procedure until the next day (mean WLS 2.30). If the procedure could not be postponed, 70.93% (n\u0026thinsp;=\u0026thinsp;61) of the respondents opted for rapid RSII, while 11.63% (n\u0026thinsp;=\u0026thinsp;10) opted for general anesthesia with endotracheal intubation without RSII. A total of 1.16% (n\u0026thinsp;=\u0026thinsp;1) preferred the use of a laryngeal mask, and 16.7% (n\u0026thinsp;=\u0026thinsp;14) performed procedural sedation despite the risk of inhalation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eQuestions 20 to 22: Field conditions for performing a gastric POCUS\u003c/h2\u003e \u003cp\u003eA total of 237 respondents answered the questions in this section, for a margin of error of 6.16%. The results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eField conditions for performing a Gastric-POCUS\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCertified Anesthesiologist\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;172)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eAnesthesiology trainee\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;65)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;237)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eState of training in Gastric POCUS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrained\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.12%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.69%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13.08%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDesire to be trained\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.02%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.62%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e72.57%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUntrained and do not want to be\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.86%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.69%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14.35%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eAvailability of abdominal US probe\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80.81%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.46%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80.17%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.95%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.08%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.97%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.46%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.86%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eGastric Point-of-care Ultrasound should be more present in basic anesthesiology training\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.42%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e90.77%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e78.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.54%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.22%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.35%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.69%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16.88%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eState of training in gastric POCUS\u003c/h2\u003e \u003cp\u003eAmong the respondents, 13.08% (n\u0026thinsp;=\u0026thinsp;31) had been trained in gastric POCUS. Conversely, 72.57% (n\u0026thinsp;=\u0026thinsp;172) of the respondents were not trained but would like to be trained, while 14.35% (n\u0026thinsp;=\u0026thinsp;34) were not trained and did not want to be trained.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eAvailability of the correct US probe\u003c/h2\u003e \u003cp\u003eRegarding the availability of the appropriate ultrasound probe, 80.17% (n\u0026thinsp;=\u0026thinsp;190) of participants had access to a low-frequency curved ultrasound probe. However, 10.97% (n\u0026thinsp;=\u0026thinsp;26) of participants did not have this probe, and 8.86% (n\u0026thinsp;=\u0026thinsp;21) were unsure of its availability.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eTraining of future specialists\u003c/h2\u003e \u003cp\u003eRegarding the training of future specialists, a majority of the 78.90% (n\u0026thinsp;=\u0026thinsp;187) of respondents were in favor of teaching gastric POCUS to trainees, while only 4.22% (n\u0026thinsp;=\u0026thinsp;10) were opposed and 16.88% (n\u0026thinsp;=\u0026thinsp;40) were neutral.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eIn Belgium, Dutch and French are the two predominant languages. To avoid potential translation errors, the authors opted for English; however, some practitioners may find its use discouraging, which could limit the response rate. Moreover, the number of survey dropouts may be explained by the potential length of the survey, despite mean completion times of 4 minutes and 39 seconds.\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eThere may be other potential influences to take into account, including the potential effect of frequent mailbox congestion on the visibility of the electronic survey or on participants' desire to engage. Nevertheless, employing professional email addresses and liaising with anesthesia departments can help to mitigate this possibility of distortion. Irrespective of the measures implemented at the outset of the study, it is not feasible to guarantee that no participant completed the survey twice. It is crucial to take into account the potential consequences of study dropouts, as they may lead to greater imprecision of responses as the questionnaire advances. The margin of error percentage had to be revised upward as the survey progressed. Additionally, inaccuracies could have been created because of survey question design and the inclusion of decoy questions to avoid response bias on our research topic.\u003c/span\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eInterpretations\u003c/h2\u003e \u003cdiv id=\"Sec29\" class=\"Section3\"\u003e \u003ch2\u003eClinical recognition of a \"high risk\" situation for the full stomach\u003c/h2\u003e \u003cp\u003eIn 20.8% of individuals, the possibility of a full stomach risk situation was suspected, either through the performance of an RSII or by specifically requesting a gastric emptying assessment. Knowledge of clinical risk factors such as severe respiratory insufficiency, independently known to be a factor for delayed gastric emptying, must be taken into account, and clinicians should be alerted to the risk of delayed gastric emptying.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eIndications, technical aspects and interpretations of gastric POCUS\u003c/h3\u003e\n\u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eA vast majority of respondents who suspected delayed gastric emptying acknowledged the necessity of gastric POCUS in our clinical setting. Nonetheless, only 13.1% of the respondents had been previously trained in the technique.\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eFor these trained individuals, the technical standards for performing gastric POCUS were well understood, with unanimous agreement on the use of a low-frequency curved ultrasound probe and the supine position followed by lateral testing. The respondents' mastery of the needed anatomical landmarks for executing the technique also proved to be highly adequate. Almost all participants could detect the presence of fluid in the stomach while interpreting the ultrasound image. Furthermore, approximately one-third of the respondents requested that the antral cross-sectional area be measured as a next step to determine whether the present fluid was abnormal. A significant portion of participants reported abnormal fluid volume based on images without measurements, which may be related to the large amount of fluid present in the image. In experienced echographers, this might result in an approximation of the filling status. It was generally agreed that the procedure should be postponed until later in the day but not until the following day. Faced with the necessity of proceeding without delay, most of the respondents with gastric ultrasound training either performed RSII or were administered general anesthesia with intubation. Despite the disclosure of a volume of gastric fluid that exceeded the high-risk threshold by more than twofold, 17% of the respondents still dispensed procedural sedation without securing the airway.\u003c/span\u003e \u003c/p\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003eEnvironmental conditions for performing a gastric POCUS\u003c/h2\u003e \u003cdiv id=\"Sec32\" class=\"Section3\"\u003e \u003ch2\u003eState of training in gastric POCUS\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eFew respondents were actually trained to perform gastric POCUS, but the demand for training was high, especially among trainees. Most users have access to the needed ultrasound equipment. Furthermore, there is significant interest in teaching this technique to future anesthesiology trainees. These findings underline the clinical benefit of this technique in cases of uncertainty about gastric filling status.\u003c/span\u003e \u003c/p\u003e \u003cdiv id=\"Sec33\" class=\"Section4\"\u003e \u003ch2\u003eGeneralizability\u003c/h2\u003e \u003cp\u003eThis study's sample size is restricted to the Belgian population because they have a distinct anesthesia training system compared to that of other neighboring countries. The variation in regulations and anesthesia practices also limits the generalizability of the outcomes to other national contexts. Consequently, identifying these differences is critical when interpreting the results. Further research is vital in every country to obtain data reflecting the specific population of each country.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eClinical recognition of a full stomach is insufficient among the general population of anesthesiologists in Belgium. Although gastric POCUS has a well-established indication for patients who are at risk for a full stomach, the proportion of trained practitioners is relatively low. Training in the gastric POCUS technique leads to a comprehensive understanding of the indications, ergonomics and ultrasound conditions. The qualitative identification of high-risk gastric contents using ultrasound has been proven effective. However, there is still a lack of complete understanding of the quantitative definition.\u003c/p\u003e \u003cp\u003eThe results of our survey indicate that a significant majority of Belgian practitioners who do not have training in gastric POCUS express a strong desire to receive such training and support its integration into the basic training program for Belgian physician assistants.\u003c/p\u003e \u003cp\u003eIncorporating point-of-care ultrasound techniques, particularly for evaluating gastric emptying, into the education of future anesthesiologists is a practical and efficient approach to mitigate complications related to anesthesia.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNIHDI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Institute for Health and Disability Insurance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePOCUS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePoint-of-care ultrasound\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRSII\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003erapid sequence induction and intubation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWLS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eweighted Likert scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe content of the survey was submitted to and approved by the Comit\u0026eacute; d\u0026apos;\u0026eacute;thique du CHU UCL Namur, site Godinne. The Ethics Committee (NUB reference number: B0392022000065) considered that answering the survey was equivalent to implicit consent.\u003c/p\u003e\n\u003cp\u003eThe survey prioritized confidentiality and data privacy by excluding questions or variables that could directly identify participants. Personalized or identifying information was not utilized during the distribution of the survey. Electronic communication via email or contact forms was utilized to disseminate the survey to anesthesiologists in Belgian hospitals. The survey was distributed by scientific societies that utilized their own distribution lists, which could not be accessed by the authors.\u003c/p\u003e\n\u003cp\u003eThe data were collected through the secure web link provided by SurveyMonkey\u0026reg;, which retained only participants\u0026apos; IP addresses; these data were deleted after 13 months. Momentive\u0026trade;, the parent company of SurveyMonkey\u0026reg;, offers a Data Processing Agreement (DPA) compliant with the European Union General Data Protection Regulations and EU and UK standard contractual clauses. The Momentive\u0026trade; Customer Data Processing Agreement was accessed at the following link: [https://fr.surveymonkey.com/mp/legal/data-processing-agreement/].\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThe SurveyMonkey\u0026reg; subscription was paid for by Dr. Adrien Maseri\u0026apos;s personal funds. No other source of funding is reported.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eA.M., D.L. and AS.D. wrote the main manuscript text, and A.M. prepared Figures 1-2 and Table 1. A.M. and D.L. designed the survey content and distributed the survey. A.M., D.L., AS.D. and Q.D., have drafted the work or substantively revised it. All the authors reviewed and approved the submitted version.\u003c/p\u003e\n\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eThe authors of the study received rigorous training in conducting gastric point-of-care ultrasound (POCUS) under the supervision of Professor Peter Van de Putte (Imeldaziekenhuis Bonheiden, Belgium), a specialist in this technique. The training covered both theoretical and practical aspects and was completed at CHU UCL Namur. To maintain regular education, the authors regularly practiced Gastric POCUS and sought updated information and resources from the website of Gastricultrasound.org (19).\u003c/p\u003e\n\u003cp\u003eThis manuscript adheres to the CROSS Guidelines (25) (Checklist for Reporting of Survey Studies) of the Equator Network.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSimpson J. The alleged case of death from the action of chloroform. The Lancet. 1848;1:175\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKing W. Pulmonary aspiration of gastric contents. Update in Anesthesia December. 2010;26(1):28\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNg A, Smith G. Gastroesophageal reflux and aspiration of gastric contents in anesthetic practice. Anesth Analg. 2001;93(2):494\u0026ndash;513.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShin D, Lebovic G, Lin RJ. In-hospital mortality for aspiration pneumonia in a tertiary teaching hospital: A retrospective cohort review from 2008 to 2018. J Otolaryngol - Head Neck Surg. 2023;52(1):23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaviv Y, D'Ovidio F, Pierre A, Chaparro C, Freeman M, Keshavjee S, et al. Prevalence of gastroparesis before and after lung transplantation and its association with lung allograft outcomes. Clin Transplant. 2012;26(1):133\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDagouassat M, Gagliolo JM, Chrusciel S, Bourin MC, Duprez C, Caramelle P, et al. The cyclooxygenase-2-prostaglandin E2 pathway maintains senescence of chronic obstructive pulmonary disease fibroblasts. Am J Respir Crit Care Med. 2013;187(7):703\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMontuschi P, Kharitonov SA, Ciabattoni G, Barnes PJ. Exhaled leukotrienes and prostaglandins in COPD. Thorax. 2003;58(7):585\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDorsey J, Gonska T. Bacterial overgrowth, dysbiosis, inflammation, and dysmotility in the Cystic Fibrosis intestine. J Cyst fibrosis: official J Eur Cyst Fibros Soc. 2017;16(Suppl 2):14\u0026ndash;s23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChaiban JT, Bitar FF, Azar ST. Effect of chronic hypoxia on leptin, insulin, adiponectin, and ghrelin. Metab Clin Exp. 2008;57(8):1019\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeindl S, Lehnert M, Cri\u0026eacute;e CP, Hasenfuss G, Andreas S. Marked sympathetic activation in patients with chronic respiratory failure. Am J Respir Crit Care Med. 2001;164(4):597\u0026ndash;601.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Gestel AJ, Steier J. Autonomic dysfunction in patients with chronic obstructive pulmonary disease (COPD). J Thorac disease. 2010;2(4):215\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZaslona Z, Peters-Golden M. Prostanoids in Asthma and COPD: Actions, Dysregulation, and Therapeutic Opportunities. Chest. 2015;148(5):1300\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Lisle RC, Meldi L, Mueller R. Intestinal smooth muscle dysfunction develops postnatally in cystic fibrosis mice. J Pediatr Gastroenterol Nutr. 2012;55(6):689\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolt S, McDicken WN, Anderson T, Stewart IC, Heading RC. Dynamic imaging of the stomach by real-time ultrasound\u0026ndash;a method for the study of gastric motility. Gut. 1980;21(7):597\u0026ndash;601.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBouvet L, Miquel A, Chassard D, Boselli E, Allaouchiche B, Benhamou D. Could a single standardized ultrasonographic measurement of antral area be of interest for assessing gastric contents? A preliminary report. Eur J Anaesthesiol. 2009;26(12):1015\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerlas A, Chan VW, Lupu CM, Mitsakakis N, Hanbidge A. Ultrasound assessment of gastric content and volume. Anesthesiology. 2009;111(1):82\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBouvet L, Mazoit JX, Chassard D, Allaouchiche B, Boselli E, Benhamou D. Clinical assessment of the ultrasonographic measurement of antral area for estimating preoperative gastric content and volume. Anesthesiology. 2011;114(5):1086\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan de Putte P, Perlas A. Ultrasound assessment of gastric content and volume. Br J Anaesth. 2014;113(1):12\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePutte PVd, Bouvet L, Kruisselbrin R, Spencer A, Arzola C. A Point-of-care tool for aspiration risk assessment 2019 [Gastricultrasound.org is a free web-based educational resource that contains information related to the performance and interpretation of point-of-care perioperative gastric ultrasound for aspiration risk assessment, based on peer-reviewed data and the opinion of the editors]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gastricultrasound.org/en/home/\u003c/span\u003e\u003cspan address=\"https://www.gastricultrasound.org/en/home/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMackenzie DC, Azad AM, Noble VE, Liteplo AS. Test performance of point-of-care ultrasound for gastric content. Am J Emerg Med. 2019;37(1):123\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerlas A, Davis L, Khan M, Mitsakakis N, Chan VW. Gastric sonography in the fasted surgical patient: a prospective descriptive study. Anesth Analg. 2011;113(1):93\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeineri M, Arellano R, Bryson G, Arzola C, Chen R, Collins P, et al. Canadian recommendations for training and performance in basic perioperative point-of-care ultrasound: recommendations from a consensus of Canadian anesthesiology academic centres. Can J Anaesth = J canadien d'anesthesie. 2021;68(3):376\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, et al. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Annals of oncology: official journal of the European Society for Medical Oncology. 2018;29(Suppl 4):iv166\u0026ndash;iv91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eService Public F\u0026eacute;d\u0026eacute;ral Sant\u0026eacute; publique SdlcaeEIdsSSP. Contacts et donn\u0026eacute;es d'agr\u0026eacute;ment des h\u0026ocirc;pitaux g\u0026eacute;n\u0026eacute;raux et psychiatriques 2021 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.health.belgium.be/fr/sante/organisation-des-soins-de-sante/partage-de-donnees-de-sante/institutions-de-soins\u003c/span\u003e\u003cspan address=\"https://www.health.belgium.be/fr/sante/organisation-des-soins-de-sante/partage-de-donnees-de-sante/institutions-de-soins\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma A, Minh Duc NT, Luu Lam Thang T, Nam NH, Ng SJ, Abbas KS, et al. A Consensus-Based Checklist for Reporting of Survey Studies (CROSS). J Gen Intern Med. 2021;36(10):3179\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Anesthesiology, Gastrointestinal Contents/diagnostic Imaging, Perioperative Care/Methods, Pneumonia, Aspiration/Prevention and Control, Ultrasonography","lastPublishedDoi":"10.21203/rs.3.rs-3721487/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3721487/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003ePulmonary aspiration syndrome remains a noteworthy complication of general anesthesia, particularly in unfasted patients. Ensuring a high degree of certainty regarding gastric emptiness is strongly associated with a reduction in the likelihood of pulmonary aspiration. Gastric point-of-care ultrasound (POCUS) allows both qualitative and quantitative assessment of gastric contents.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003e The survey, created and approved by two certified anesthesiologists trained to perform gastric POCUS, was distributed to Belgian certified anesthesiologists and trainees between April 2020 and June 2021. Participants were provided with a simulated clinical case of a patient at risk for gastric aspiration according to his medical history. The objective of this study was to assess the identification of clinical high-risk situations for gastric aspiration, the importance of the gastric POCUS criteria, the importance of understanding the technical and practical features of the procedure, and the potential impact of the procedure on the induction plan for general anesthesia. The survey utilized conditional branching to ensure unbiased responses to POCUS-related questions. The questionnaire included multiple-choice questions, quantitative variables, and 5-point Likert scales. Daniel's formula, corrected for a finite population, was used to calculate the margin of error.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eThe survey was completed by 323 anesthesiologists. Among them, only 20.8% (27) identified the risk of a full stomach based on the patient's history. Anesthesiologists who recognized the indication for gastric POCUS and were trained in the procedure demonstrated good recall of the practical conditions for performing the procedure and interpreting the results. Only 13.08% (31) of all respondents had received training in gastric POCUS, while 72.57% (172) expressed interest in future training. Additionally, 80.17% (190) of the participants had access to adequate ultrasound equipment, and 78.90% (187) endorsed teaching gastric POCUS to anesthesiology trainees.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eThis survey provides insight into the epidemiology, clinical recognition, knowledge, and utilization of gastric POCUS among Belgian anesthesia professionals. The results highlight the importance of appropriate equipment and training to ensure the safe and effective implementation of gastric POCUS in anesthesia practice. Additional efforts should focus on enhancing training and encouraging the integration of gastric POCUS into daily clinical practice.\u003c/p\u003e","manuscriptTitle":"Clinical recognition of a potentially full stomach and use of point-of-care gastric ultrasound (POCUS) by anesthesiologists: a Belgian survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-03 15:13:07","doi":"10.21203/rs.3.rs-3721487/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-02-07T10:26:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-01-19T19:00:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"64a3e71c-dbf8-4f96-b371-3ca88e45cf25","date":"2024-01-19T18:14:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-01-18T19:16:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-01-18T19:06:13+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2023-12-31T10:22:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-12-31T10:21:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2023-12-07T16:17:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"df634520-288a-4428-8b37-02655ba11721","owner":[],"postedDate":"January 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-04-15T15:08:18+00:00","versionOfRecord":{"articleIdentity":"rs-3721487","link":"https://doi.org/10.1186/s12909-024-05359-5","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2024-04-08 15:00:58","publishedOnDateReadable":"April 8th, 2024"},"versionCreatedAt":"2024-01-03 15:13:07","video":"","vorDoi":"10.1186/s12909-024-05359-5","vorDoiUrl":"https://doi.org/10.1186/s12909-024-05359-5","workflowStages":[]},"version":"v1","identity":"rs-3721487","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3721487","identity":"rs-3721487","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}