Bedside gastrointestinal ultrasound combined with acute gastrointestinal injury score to guide enteral nutrition therapy in critically patients

Abstract

Background To use gastric ultrasound to evaluate function and to determine the start time of enteral nutrition (EN) in patients with acute gastrointestinal injury (AGI). Methods We reviewed records from 105 patients who suffered AGI levels two (AGI II). We recorded several data points, including ultrasonographic transverse area of gastric antrum (CSA), left descending colonic or right ascending colonic diameter (Diam), peristatic frequency (Peri), EN start time, EN dose, prealbumin (PA), and EN complications. The recovery of intestinal function after EN treatment was judged as success. If there was EN treatment complication, this was judged as failure. We analyzed the changes in gastrointestinal function after EN treatment, to determine feeding time. Results There were 69 patients in the successful group, and 36 in the failure group. There were no significant differences between the two groups in age, intra abdominal pressure (IAP), APACHE II, PA and disease composition (p > 0.05).There were significant differences in terms of EN startup time, CSA, Diam, Peri, and PA, between the EN success and failure groups. We found IAP does not reflect gastrointestinal function;CSA ≤ 9cm2, Diam ≤ 2.9 cm, Peri > 3 bpm, indicated that the three indexes could reflect the recovery of gastrointestinal function. Receiver operating curve analysis showed that combined CSA, Diam, Peri evaluation determined the best time to start EN. Conclusions Monitoring gastric antrum transversal area, colonic diameter, colonic peristatic frequency using ultrasound can guide the timing of initiation of enteral nutrition treatment.

Gastrointestinal function in critically ill patients

“…Some development is also reported in point-of-care ultrasound assessment of certain intestinal pathologies and abdominal venous congestion [36,37]. One study reported assessment of enteral feeding intolerance with measuring gastric antrum, colonic diameter and peristaltic frequency [38], while standardized protocol for gastrointestinal ultrasound in critical illness is still lacking [39].…”

Role of gastric ultrasound to guide enteral nutrition in the critically ill

“…Lai et al [13 ▪▪ ] used a combined assessment of gastrointestinal function by CSA colonic diameter, peristaltic frequency, and other indicators to predict recovery of intestinal function. They found that individually CSA ≤9 cm 2 had an area under the curve (AUC) of 0.896; colonic diameter ≤2.9 cm, AUC of 0.92; and peristaltic frequency >3 bowel peristaltic movement (BPM), AUC of 0.845.…”

“…The authors concluded that with these findings, enteral nutrition therapy could be initiated earlier without complications after a complete evaluation of gastrointestinal function. Gastrointestinal POCUS can better evaluate the damaged state of gastrointestinal track, and enteral nutrition therapy can be carried out earlier [13 ▪▪ ].…”

“…The potential utility of ultrasonography for monitoring gastrointestinal function and dysfunction in critical care settings may lead to appropriate therapeutic interventions. Together, they offer a sound basis for dynamic imaging of the gastrointestinal patient's condition and can obtain valuable and better information than subjective clinical evaluations [12,13 ▪▪ ].…”