Abdominal signs and symptoms in intensive care patients

Blaser, Annika Reintam; Starkopf, Joel; Malbrain, Manu L N G

doi:10.5603/ait.a2015.0022

Cited by 31 publications

(23 citation statements)

References 83 publications

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“…The rationale is to improve splanchnic perfusion to prevent or overcome dysfunction and to preserve the intestinal microbiome. 24 …”

Section: Discussionmentioning

confidence: 99%

The frequency, risk factors, and complications of gastrointestinal dysfunction during enteral nutrition in critically ill patients

Atasever¹,

Ozcan²,

Kaşalı³

et al. 2018

TCRM

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BackgroundGastrointestinal (GI) motility disorders in intensive care patients remain relatively unexplored. Nowadays, the frequency, risk factors and complications of GI dysfunction during enteral nutrition (EN) become more questionable.AimTo evaluate the frequency, risk factors and complications of GI dysfunction during EN in the first 2 weeks of the intensive care unit (ICU) stay and to identify precautions to prevent the development of GI dysfunction and avoid complications.MethodsIn this prospective observational study, we deliberately targeted at-risk patients. A total of 137 patients who received nasogastric tube feeding in an ICU of a tertiary hospital were enrolled.ResultsThe incidence of GI dysfunction that was found to be 63% which was associated mainly between MDR bacteria positivity and negative fluid balance. Diarrhea was observed in 36 patients (26%) and on 147 patient-days (incidence rate, 5.5 per 100 patient-days). The median day of diarrhea onset was 6 days after the initiation of EN. Forty patients (29%) presented with constipation (85% during the first week). Fifty patients (36%) exhibited upper digestive intolerance on 212 patient-days (incidence rate, 7.9 per 100 patient-days), after a median EN duration of 6 days (range, 2–14 days). Logistic regression analysis revealed MDR bacteria growth in the culture (OR, 1.75; 95% CI, 1.15–2.67; P=0.008) and negative fluid balance (OR, 0.57; 95% CI, 0.34–0.94; P=0.03) as the risk factors for GI dysfunction. We also showed that GI dysfunction was associated with high SOFA score, hypoalbuminemia, catecholamine use, and prolonged length of stay (LOS). GI dysfunction, on the other hand, can cause some complications including inadequate nutrition, and newly developed decubitus ulcers.ConclusionGI dysfunction should be considered a clinical predictor of inadequate nutrition and prolonged LOS. In addition, the most dramatic risk for GI dysfunction was observed in patients with MDR bacteria growth in the culture and patients in negative fluid balance. Intensivists provide appropriate nutrition for patients, as well as prompt intervention and the development of treatment strategies in the event of GI dysfunction.

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“…The rationale is to improve splanchnic perfusion to prevent or overcome dysfunction and to preserve the intestinal microbiome. 24 …”

Section: Discussionmentioning

confidence: 99%

The frequency, risk factors, and complications of gastrointestinal dysfunction during enteral nutrition in critically ill patients

Atasever¹,

Ozcan²,

Kaşalı³

et al. 2018

TCRM

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“…GI dysfunction and its severity were demonstrated to influence the ICU outcome in previous studies [1, 2, 17–19], but the absence of a scaled system for assessing GI function has been a major limiting factor in these studies. Since the introduction of the AGI grading system recommended by the ESICM in 2012, few studies have investigated the association between GI dysfunction stratified using the AGI grading system and clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

Severity of acute gastrointestinal injury grade is a predictor of all-cause mortality in critically ill patients: a multicenter, prospective, observational study

Sun

et al. 2017

Crit Care

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BackgroundIn 2012, the European Society of Intensive Care Medicine proposed a definition for acute gastrointestinal injury (AGI) based on current medical evidence and expert opinion. The aim of the present study was to evaluate the feasibility of using the current AGI grading system and to investigate the association between AGI severity grades with clinical outcome in critically ill patients.MethodsAdult patients at 14 general intensive care units (ICUs) with an expected ICU stay ≥24 h were prospectively studied. The AGI grade was assessed daily on the basis of gastrointestinal (GI) symptoms, intra-abdominal pressures, and feeding intolerance (FI) in the first week of admission to the ICU.ResultsAmong the 550 patients enrolled, 456 patients (82.9%) received mechanical ventilation, and 470 patients were identified for AGI. The distribution of the global AGI grade was 24.5% with grade I, 49.4% with grade II, 20.6% with grade III, and 5.5% with grade IV. AGI grading was positively correlated with 28- and 60-day mortality (P < 0.0001). Univariate Cox regression analysis showed that age, sepsis, diabetes mellitus, coronary artery disease, the use of vasoactive drugs, serum creatinine and lactate levels, mechanical ventilation, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and the global AGI grade were significantly (P ≤ 0.02) associated with 60-day mortality. In a multivariate analysis including these variables, diabetes mellitus (HR 1.43, 95% CI 1.03–1.87; P = 0.05), the use of vasoactive drugs (HR 1.56, 95% CI 1.12–2.11; P = 0.01), serum lactate (HR 1.15, 95% CI 1.06–1.24; P = 0.03), global AGI grade (HR 1.65, 95% CI 1.28–2.12; P = 0.008), and APACHE II score (HR 1.04, 95% CI 1.02–1.06; P < 0.001) were independently associated with 60-day mortality. In a subgroup analysis of 402 patients with 7-day survival, in addition to clinical predictors and the AGI grade on the first day of ICU stay, FI within the first week of ICU stay had an independent and incremental prognostic value for 60-day mortality (χ2 = 41.9 vs. 52.2, P = 0.007).ConclusionsThe AGI grading scheme is useful for identifying the severity of GI dysfunction and could be used as a predictor of impaired outcomes. In addition, these results support the hypothesis that persistent FI within the first week of ICU stay is an independent determinant for mortality.Trial registrationChinese Clinical Trial Registry identifier: ChiCTR-OCS-13003824. Registered on 29 September 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1780-4) contains supplementary material, which is available to authorized users.

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“…[ 18 ] A large number of previous studies confirmed the relationship between gastrointestinal dysfunction and the severity and the clinical outcome of the disease. [ 19 20 ] Therefore, gastrointestinal dysfunction has become an unnegligible problem for ICU patients.…”

Section: Discussionmentioning

confidence: 99%

Effect of Rhubarb on Gastrointestinal Dysfunction in Critically Ill Patients

Zhang

Wang

Chen

2018

Chinese Medical Journal

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Background:Gastrointestinal dysfunction plays a critical role in the prognosis of critically ill patients. Previous studies showed rhubarb, a traditional Chinese herb, can protect the intestinal barrier function, prevent intestinal bacterial translocation, and promote gastrointestinal peristalsis, but the clinical studies are less. The aim of this study was to evaluate the effects of rhubarb on gastrointestinal dysfunction in critically ill patients.Methods:From June 2015 to May 2017, a total of 368 critically ill patients with Grade I–III acute gastrointestinal injury (AGI) were enrolled in this study. Patients were divided into two groups according to the exposure factors (whether the patients received rhubarb treatment): the rhubarb group and the usual treatment group. Clinical data were collected within the first 24 h of the Intensive Care Unit (ICU) admission and 7 days after treatment. Survival data on day 28 after ICU admission and the durations of ICU and total hospitalization were also collected. Propensity score matching (PSM) was conducted to reduce confounding bias between the groups. The logistic regression was conducted to screen the influence factors.Results:The eligible patients were divided into rhubarb group (n = 219, 59.5%) and usual treatment group (n = 149, 40.5%). Before PSM, the remission rate of feeding intolerance in rhubarb group and usual treatment group were 59.8% and 39.6%, respectively. After PSM, the remission rate of feeding intolerance in rhubarb group and usual treatment group was 77.9% and 30.9%, respectively. The remission rates of feeding intolerance in rhubarb group were significantly higher than those in the usual treatment group (all P < 0.05). Compared with the usual treatment group, the rhubarb group had a higher rate of AGI improvement, lower level of C-reactive protein, shorter stay in ICU before and after PSM (P < 0.05). There was no significant difference in 28-day mortality between rhubarb and usual treatment groups before and after PSM (48 vs. 33, P = 0.959; and 16 vs. 21, P = 0.335). The logistic regression analysis showed that the single factor, whether receiving rhubarb therapy, affected the proportion of patients whose enteral nutrition needs ≥83.7 kJ·kg−1·d−1 after 7 days of treatment (odds ratio: 7.908, 95% confidence interval: 3.661–17.083, P < 0.001). No serious adverse effects were found in two groups.Conclusions:The rhubarb might significantly improve feeding tolerance and relieve gastrointestinal dysfunction in critically ill patients, without serious adverse reactions. It provided proof for the treatment of gastrointestinal dysfunction with rhubarb during clinical practice.

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Abdominal signs and symptoms in intensive care patients

Cited by 31 publications

References 83 publications

The frequency, risk factors, and complications of gastrointestinal dysfunction during enteral nutrition in critically ill patients

The frequency, risk factors, and complications of gastrointestinal dysfunction during enteral nutrition in critically ill patients

Severity of acute gastrointestinal injury grade is a predictor of all-cause mortality in critically ill patients: a multicenter, prospective, observational study

Effect of Rhubarb on Gastrointestinal Dysfunction in Critically Ill Patients

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