• TackenMarijn C TMCTFrom the Department of Anaesthesiology, Radboudumc, Nijmegen, The Netherlands (MCTT, TAJvL, PvdP, CK), the Department of Anaesthesiology, Imeldaziekenhuis, Bonheiden, Belgium (PvdP), the Department of Anesthesia and Pain Management, Tor, Tristan A J van Leest, Peter van de Putte, Christiaan Keijzer, and Anahi Perlas.
• From the Department of Anaesthesiology, Radboudumc, Nijmegen, The Netherlands (MCTT, TAJvL, PvdP, CK), the Department of Anaesthesiology, Imeldaziekenhuis, Bonheiden, Belgium (PvdP), the Department of Anesthesia and Pain Management, Toronto Western Hospital (AP), the Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada (AP).
• Eur J Anaesthesiol. 2021 Dec 1; 38 (12): 122312291223-1229.

BackgroundEnteral nutrition is essential in the treatment of critically ill patients. Current methods to monitor enteral nutrition such as aspiration of residual volume may be inaccurate. Gastric ultrasonography estimates total gastric fluid volume using the Perlas model, but this model is validated for clear fluids only, and its accuracy for measuring thick fluids is unknown.ObjectivesThe primary aim of this study was to evaluate the Perlas model for gastric volume estimation of enteral nutrition, a thick fluid product.DesignA single-centre, single blinded, randomised controlled study.SettingSingle university hospital, from May to July 2019.ParticipantsSeventy-two healthy fasted volunteers were randomly allocated to different fluid volume groups.InterventionParticipants randomly ingested predetermined volumes between 50 and 400 ml of a feeding-drink (Nutricia Nutridrink). Following a standardised gastric ultrasound scanning protocol, a blinded sonographer measured the antral cross-sectional area in the supine and right-lateral decubitus positions.Main Outcome MeasuresMeasurements were performed at baseline, 5 min postingestion and 20 min postingestion. Gastric volumes were predicted using the previously established Perlas model and compared with total gastric fluid volumes after ingestion of the study drink.ResultsThe Perlas model underestimated the volume of thick gastric fluid and yielded a suboptimal fit for our data. However, antral cross-sectional area and total gastric thick fluid volumes were significantly correlated (Pearson's correlation coefficient 0.73, P < 0.01). A new model was fitted to predict gastric volumes of thick fluids, using the antral cross-sectional area (cm2) in the right-lateral decubitus position: Volume (ml) = 79.38 + 13.32 x right-lateral cross-sectional area.ConclusionThe Perlas model for clear gastric fluid volume estimation is suboptimal for thick fluid volume assessment and an alternative model is presented.Clinical Trial RegistrationNetherlands Trial Register Trial NL7677, Registration date: 16 April 2019; https://www.trialregister.nl/trial/7677.Copyright © 2021 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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