Gastrointestinal complications in critical care patients and effects of mechanical ventilation on the gastrointestinal tract

Abstract

Patients in the intensive care unit (ICU) especially those who require mechanical ventilation are at increased risk for developing gastrointestinal (GI) complications such as bleeding, infection, and motility dysfunction. It is estimated that the prevalence of GI complications in those patients is approximately 50-80% and lots of those go undiagnosed. Complications can affect different parts of the GI system, including the esophagus, stomach, small intestine, large intestine, liver, and pancreas. Effects might include dysmotility, diarrhea, inflammation, infection, direct mucosal injuries, ulcerations, and bleeding, and it can be associated with high mortality rates. Moreover, it is believed that the GI tract has a significant contribution in the development of multiple organ dysfunction syndrome (MODS) in critically ill patients. Mechanical ventilation either alone or in association with other critical illness may have a multitude of effects on almost all the organs of the gastro-intestinal tract. Attention of those interaction and side effects can improve outcomes and potentially mortality. In this review, we describe the mechanisms proposed for mechanical ventilation induced GI complications and different GI complications which can affect the critically ill patient. Keywords: PEEP, Prone position, Dysmotility, GERD, GI bleeding, Ileus, Aspiration, Acalculous cholecystitis

Management of gastrointestinal and nutritional problems in children on home invasive mechanical ventilation

“…29,30 The gastro-esophageal reflux (GER) disease, dysphagia, delayed gastric emptying and constipation are the most common GI problems of the children with tracheostomy on MV. [31][32][33] 2.1 | Ger disease impairement. [35][36][37][38] In the study of mechanical ventilated critically ill patients, the basal LES pressure was found to be low and a minimal increase in abdominal pressure due to suctioning, straining, coughing may cause frequent reflux episodes.…”

“…39 Enteral nutrition related gastric distension or delayed gastric emptying may increase the frequency of TLESRs and cause increased GER episodes in these patients. 31 Newton et al 40 reported that GERD was diagnosed in 20% of the children with tracheostomy and of these children 12.4% had tracheostomy related complications, with odds ratio of 1.5 for developing tracheostomy related complications. Ertuğrul et al 41 demonstrated that GERD was the major co-morbidity (28%) in children dependent HIMV, most of them had an underlying a neuromuscular disease.…”

“…Also electrolyte disturbances and hyperglycemia may worsen gastric emptying. 27,31,[57][58][59] In tube fed children with neuromuscular disorders delayed gastric emptying has been reported. The children with DMA, the delay reported to be related to gastric smooth muscle involvement.…”

“…If it does not resolve a jejunal tube placement or total parenteral nutrition can be considered to achieve feeding. 31 Small volume, frequent, low-fat and low fiber content feeding may be given in stable patients. 58 Gastric emptying is significantly faster with whey based formula compared to casein based formula.…”

“…The decrease in portal flow may be compansated with increased arterial blood flow to maintain hepatic blood flow 29,30 . The gastro‐esophageal reflux (GER) disease, dysphagia, delayed gastric emptying and constipation are the most common GI problems of the children with tracheostomy on MV 31–33 …”