Altered GI Motility in Critically Ill Patients

Ukleja, Andrew

doi:10.1177/0884533609357568

Cited by 107 publications

(31 citation statements)

References 92 publications

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“…This applies in particular to critically ill patients, in whom gastroduodenal atony, caused by increased intracranial pressure, hyperglycemia and stress, can lead to delayed or impaired gastric emptying and decreased transpyloric transport of nutrients (for extended review see Waseem et al [161,166] ). However, the results of more than 10 controlled clinical trials [134,[167][168][169][170][171][172][173][174][175] are contrary and inconclusive, particularly with regard to nasoenteral tube feeding [164,168] .…”

Section: Probiotics Controlsmentioning

confidence: 98%

“…Alberda et al [205] Adults starting EN on ICU VSL#3 -live cells 10/9 (9) 9 × 10 11 mg/d 14%/12% 1 of days with diarrhea 23% of days with diarrhea Frohmader et al [206] Adults starting EN on ICU VSL#3 45 (25) 9 × 10 11 mg/d 0.5 liquid stools/d 1.1 liquid stools/d Ferrie et al [207] Adults with diarrhea during EN on ICU [25,[158][159][160] and is caused by a combination of gravitational back-flow, impairment of the lower esophageal sphincter (LES), lack of swallow-induced LES relaxation, infrequent esophageal body contractions, and the presence of the tube across the gastric cardia [161] . It is very common in patients with impaired consciousness or poor gag reflexes, occurring in up to 30% of those with tracheotomies [162] and 12.5% of neurology patients [163] .…”

Section: Probiotics Controlsmentioning

confidence: 99%

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Gastroenteric tube feeding: Techniques, problems and solutions

Blumenstein

Shastri

Stein

2014

WJG

351

288

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Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake, chronic neurological or mechanical dysphagia or gut dysfunction, and patients who are critically ill. However, despite the benefits and widespread use of enteral tube feeding, some patients experience complications. This review aims to discuss and compare current knowledge regarding the clinical application of enteral tube feeding, together with associated complications and special aspects. We conducted an extensive literature search on PubMed, Embase and Medline using index terms relating to enteral access, enteral feeding/nutrition, tube feeding, percutaneous endoscopic gastrostomy/jejunostomy, endoscopic nasoenteric tube, nasogastric tube, and refeeding syndrome. The literature showed common routes of enteral access to include nasoenteral tube, gastrostomy and jejunostomy, while complications fall into four major categories: mechanical, e.g., tube blockage or removal; gastrointestinal, e.g., diarrhea; infectious e.g., aspiration pneumonia, tube site infection; and metabolic, e.g., refeeding syndrome, hyperglycemia. Although the type and frequency of complications arising from tube feeding vary considerably according to the chosen access route, gastrointestinal complications are without doubt the most common. Complications associated with enteral tube feeding can be reduced by careful observance of guidelines, including those related to food composition, administration rate, portion size, food temperature and patient supervision.

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Section: Probiotics Controlsmentioning

confidence: 98%

Section: Probiotics Controlsmentioning

confidence: 99%

Gastroenteric tube feeding: Techniques, problems and solutions

Blumenstein

Shastri

Stein

2014

WJG

351

288

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“…Additionally, ICU patients are more likely to receive PPIs for stress ulcer prophylaxis or active gastrointestinal bleeding. In the ICU compared to other hospital locations, there is increased use of antibiotics, luminal penetration of antibiotics, gut wall edema, and derangements in gastrointestinal motility (33). For all of these reasons, traditional risk factors such as antibiotics and PPIs may have distinct relationships with risk for CDI when CDI arises in the ICU setting.…”

Section: Introductionmentioning

confidence: 99%

Proton Pump Inhibitors Do Not Increase Risk for Clostridium difficile Infection in the Intensive Care Unit

Faleck

Salmasian

Furuya

et al. 2016

American Journal of Gastroenterology

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Objectives Patients in the intensive care unit (ICU) frequently receive proton pump inhibitors (PPIs) and have high rates of Clostridium difficile infection (CDI). PPIs have been associated with CDI in hospitalized patients, but ICU patients differ fundamentally from non-ICU patients and few studies have focused on PPI use exclusively in the critical care setting. We performed a retrospective cohort study to determine the associations between PPIs and healthcare facility–onset CDI in the ICU. Methods We analyzed data from all adult ICU patients at three affiliated hospitals (14 ICUs) between 2010–2013. Patients were excluded if they had recent CDI or an ICU stay of <3 days. We parsed electronic medical records for ICU exposures, focusing on PPIs and other potentially modifiable exposures that occurred during ICU stays. Healthcare facility–onset CDI in the ICU was defined as a newly positive PCR for the C. difficile toxin B gene from an unformed stool, with subsequent receipt of anti-CDI therapy. We analyzed PPIs and other exposures as time-varying covariates and used Cox proportional hazards modeling to adjust for demographics, comorbidities, and other clinical factors. Results Of 18,134 patients who met criteria for inclusion, 271 (1.5%) developed healthcare facility–onset CDI in the ICU. Receipt of antibiotics was the strongest risk factor for CDI (adjusted HR (aHR) 2.79; 95% confidence interval (CI), 1.50–5.19). There was no significant increase in risk for CDI associated with PPIs in those who did not receive antibiotics (aHR 1.56; 95% CI, 0.72–3.35), and PPIs were actually associated with a decreased risk for CDI in those who received antibiotics (aHR 0.64; 95% CI, 0.48–0.83). There was also no evidence of increased risk for CDI in those who received higher doses of PPIs. Conclusions Exposure to antibiotics was the most important risk factor for healthcare facility–onset CDI in the ICU. PPIs did not increase risk for CDI in the ICU regardless of use of antibiotics.

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“…Pulmoner aspirasyon, hastaların supin pozisyonda nazogastrik tüp ile beslendiği durumlarda sık görülmektedir (10)(11)(12)(13) . Bu geri kaçış, alt özefagus sifinkterinin bozulmuş relaksasyonu, yetersiz özefagus gövde kontraksiyonu ve gastrik kardiyadan geçen tüp varlığı birlikteliği ile ortaya çıkmaktadır (10,14) . PEG aspirasyon riskini tam olarak ortadan kaldırmasa da azaltabilmektedir (10,15) .…”

Section: Discussionunclassified

Percutaneous endoscopic gastrostomy in intensive care unit

Gürsoy¹,

Uğur²,

Çivi³

2015

MedJ

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GİRİŞEnteral nütrisyon (EN); yoğun bakım hastalarında gastrointestinal sistemin normal florasının ve yapı-sal bütünlüğünün korunması, translokasyon riskinin azaltılması, bağırsağın immun ve endokrin fonksiyonlarının devamlılığının sağlanması ve ciddi hastalıkların neden olduğu katabolik süreci sınırlamada kritik rol oynamaktadır (1) . Yoğun bakım hastalarında enteral nütrisyonu sağlamada ilk tercih edilen yol oral

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Altered GI Motility in Critically Ill Patients

Cited by 107 publications

References 92 publications

Gastroenteric tube feeding: Techniques, problems and solutions

Gastroenteric tube feeding: Techniques, problems and solutions

Proton Pump Inhibitors Do Not Increase Risk for Clostridium difficile Infection in the Intensive Care Unit

Percutaneous endoscopic gastrostomy in intensive care unit

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