Comparison of different definitions of feeding intolerance: A retrospective observational study

Blaser, Annika Reintam; Starkopf, Liis; Deane, Adam M.; Poeze, Martijn; Starkopf, Joel

doi:10.1016/j.clnu.2014.10.006

Cited by 76 publications

(62 citation statements)

References 22 publications

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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%

“…In a prospective study including 264 patients mechanically ventilated on admission and with an ICU stay >24 h, the mean GIF score based on the combination of FI with IAP during the first 3 days in the ICU was identified as an independent risk factor for ICU mortality (OR 3.02, 95% CI 1.63–5.59; P < 0.001) [1]. In addition, the GIF, which was defined as the presence of FI, GI hemorrhage, and/or ileus, has also been indicated to be significantly correlated with an increased risk of mortality, as well as with prolonged ICU stay and mechanical ventilation, in a retrospective analysis of 252 adult patients from 3 ICUs [19]. …”

Section: Discussionmentioning

confidence: 99%

“…In a retrospective observational study, Reintam et al observed that the frequency of FI and the association between FI and mortality varied widely and depended on the definition used. Of these various definitions, the definition of FI based on the presence of at least three of five GI symptoms was the most strongly related to ICU mortality, whereas EN <23% of the caloric target had the strongest predictive power for 90-day mortality [19]. In a recent meta-analysis (5 studies and 897 patients), FI was shown to be associated with increased mortality and prolonged ICU stay [6].…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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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“…The primary outcome was the daily adequacy of enteral feed delivered, as assessed by average percentage goal volume (delivered/prescribed × 100), before the development of intolerance, from the first study dose until permanent discontinuation of EN, because of discharge or removal of enteral feeding tube, or the development of enteral feed intolerance, defined as 2 consecutive GRVs ≥250 mL, or censored on the last dosing day if the participant did not have intolerance. A study day was a day on which the participant received study drug and there were available nutrition data (including no nutrition), with the first day being a partial day from dose administration to midnight.…”

Section: Methodsmentioning

confidence: 99%

Nutrition Adequacy Therapeutic Enhancement in the Critically Ill: A Randomized Double‐Blind, Placebo‐Controlled Trial of the Motilin Receptor Agonist Camicinal (GSK962040): The NUTRIATE Study

Deane

Lamontagne

Dukes

et al. 2017

J Parenter Enteral Nutr

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“…Gastrointestinal dysfunctions are the major cause of FI. Most doctors and studies have focused on the upper gastrointestinal dysfunctions especially gastroparesis since they are more likely to present nausea, vomiting, and gastric retention; particularly, gastric residual volume (GRV) is the most frequently used parameter to monitor FI, whereas the lower gastrointestinal factors were often neglected [3, 4]. However, the stomach and small intestine may function properly, but FI still exists which could be the result of colonic dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Acute Colonic Pseudo-Obstruction with Feeding Intolerance in Critically Ill Patients: A Study according to Gut Wall Analysis

Zhao

Xie

et al. 2017

Gastroenterology Research and Practice

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Objective. To compare the differences between acute colonic pseudo-obstruction (ACPO) with and without acute gut wall thickening. Methods. ACPO patients with feeding tolerance were divided into ACPO with no obvious gut wall thickening (ACPO-NT) group and ACPO with obvious acute gut wall thickening (ACPO-T) group according to computed tomography and abdominal radiographs. Patients' condition, responses to supportive measures, pharmacologic therapy, endoscopic decompression, and surgeries and outcomes were compared. Results. Patients in ACPO-T group had a significantly higher APACHE II (11.82 versus 8.25, p = 0.008) and SOFA scores (6.47 versus 3.54, p < 0.001) and a significantly higher 28-day mortality (17.78% versus 4.16%, p = 0.032) and longer intensive care unit stage (4 versus 16 d, p < 0.001). Patients in ACPO-NT group were more likely to be responsive to supportive treatment (62.50% versus 24.44%, p < 0.001), neostigmine (77.78% versus 17.64%, p < 0.001), and colonoscopic decompression (75% versus 42.86%, p = 0.318) than those in ACPO-T group. Of the patients who underwent ileostomy, 81.25% gained benefits. Conclusions. ACPO patients with gut wall thickening are more severe and are less likely to be responsive to nonsurgical treatment. Ileostomy may be a good option for ACPO patients with gut wall thickening who are irresponsive to nonsurgical treatment.

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Comparison of different definitions of feeding intolerance: A retrospective observational study

Cited by 76 publications

References 22 publications

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

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

Nutrition Adequacy Therapeutic Enhancement in the Critically Ill: A Randomized Double‐Blind, Placebo‐Controlled Trial of the Motilin Receptor Agonist Camicinal (GSK962040): The NUTRIATE Study

Acute Colonic Pseudo-Obstruction with Feeding Intolerance in Critically Ill Patients: A Study according to Gut Wall Analysis

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