Gastrointestinal Complications in Critically Ill Patients With COVID-19

Kaafarani, Haytham M.A.; Moheb, Mohamad El; Hwabejire, John O.; Naar, Leon; Christensen, Mathias A.; Breen, Kerry; Gaitanidis, Apostolos; Alser, Osaid; Mashbari, Hassan; Bankhead‐Kendall, Brittany; Mokhtari, Ava K.; Maurer, Lydia R.; Kapoen, Carolijn; Langeveld, Kimberly; Hechi, Majed W. El; Lee, Jarone; Mendoza, April E.; Saillant, Noelle; Parks, Jonathan; Fawley, Jason; King, David R.; Fagenholz, Peter J.; Velmahos, George C.

doi:10.1097/sla.0000000000004004

Cited by 181 publications

(232 citation statements)

References 5 publications

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“…This report includes data from 141 patients with COVID-19 (58%) whose overall gastrointestinal complications have been previously described. 3 The median age of patients was 60.5 years (interquartile range, 48-71) and 62 years (interquartile range, 53-73.5) for patients with and without COVID-19, respectively, and the percentage of males was 66.5% and 54.9%, respectively. Ninety-two patients with COVID-19 and ARDS were propensity score matched to 92 patients with non-COVID-19 ARDS (Table).…”

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confidence: 96%

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Gastrointestinal Complications in Critically Ill Patients With and Without COVID-19

Moheb

Naar

Christensen

et al. 2020

JAMA

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114

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Coronavirus disease 2019 (COVID-19) appears to have significant extrapulmonary complications affecting multiple organ systems. 1-3 Critically ill patients with COVID-19 often develop gastrointestinal complications during their hospital stay, including bowel ischemia, transaminitis, gastrointestinal bleeding, pancreatitis, Ogilvie syndrome, and severe ileus. 3 Whether the high incidence of gastrointestinal complications is a manifestation of critical illness in general or is specific to COVID-19 remains unclear. We compared the incidence of gastrointestinal complications of critically ill patients with COVID-19-induced acute respiratory distress syndrome (ARDS) vs comparably ill patients with non-COVID-19 ARDS using propensity score analysis. Methods | All patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on reverse transcriptase-polymerase chain reaction who were intubated and admitted to 1 of 13 (preexistent and surge) intensive care units (ICUs) of the Massachusetts General Hospital between March 13, 2020, and May 7, 2020, were included, then matched to a cohort of patients admitted between 2018 and 2019 and meeting the Berlin criteria for ARDS. 4 No changes

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confidence: 96%

“…Three of the 4 patients with COVID-19 and bowel ischemia were taken to the operating room and had intraoperative findings consistent with COVID-19 bowel as previously described in different patients. 3 Pathology findings demonstrated fibrin thrombi in the microvasculature underlying areas of necrosis.…”

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confidence: 99%

Gastrointestinal Complications in Critically Ill Patients With and Without COVID-19

Moheb

Naar

Christensen

et al. 2020

JAMA

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114

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“…However, there are few reports of paralytic ileus in patients with COVID-19. Kaafarani et al 18 described a series of 141 critically ill patients with COVID-19, where half of the patients developed hypomotility-related complications of variable severity. Only two patients were diagnosed with a colonic paralytic ileus (Ogilvie's syndrome).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Paralytic Ileus: A Potential Extrapulmonary Manifestation of Severe COVID-19

Ibrahim

Karuppasamy

Parambil

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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The COVID-19 pandemic has recently spread worldwide, presenting primarily in the form of pneumonia or other respiratory disease. In addition, gastrointestinal manifestations have increasingly been reported as one of the extrapulmonary features of the virus. We report two cases of SARS-CoV-2 infection complicated by paralytic ileus. The first patient was a 33-year-old man who was hospitalized with severe COVID-19 pneumonia requiring ventilator support and intensive care. He developed large bowel dilatation and perforation of the mid-transverse colon, and underwent laparotomy and colonic resection. Histopathology of the resected bowel specimen showed acute inflammation, necrosis, and hemorrhage, supporting a role for COVID-19-induced micro-thrombosis leading to perforation. The second patient was a 33-year-old man who had severe COVID-19 pneumonia, renal failure, and acute pancreatitis. His hospital course was complicated with paralytic ileus, and he improved with conservative management. Both cases were observed to have elevated liver transaminases, which is consistent with other studies. Several authors have postulated that the angiotensin-converting enzyme 2 receptors, the host receptors for COVID-19, that are present on enterocytes in both the small and large bowel might mediate viral entry and resultant inflammation. This is a potential mechanism of paralytic ileus in cases of severe COVID-19 infection. Recognizing paralytic ileus as a possible complication necessitates timely diagnosis and management.

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“…15 In a study by Kaafarani et al, half of the 141 COVID-19 patients admitted to the intensive care unit (ICU) developed hypomotility-related complications showing clinical or radiographic evidence of ileus. 27 GI intolerance can manifest as unexplained abdominal pain, nausea, vomiting, diarrhea, or significant abdominal dis-tention. Dilated bowel loops with air and fluid levels and pneumatosis intestinalis may be observed on serial abdominal exams.…”

Section: The Challenge Of Gi Intolerancementioning

confidence: 99%

Gastrointestinal Manifestations of COVID‐19: Impact on Nutrition Practices

Aguila

Fontanilla

et al. 2020

Nut in Clin Prac

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Although Coronavirus disease 2019 (COVID‐19) is primarily a respiratory disease, growing evidence shows that it can affect the digestive system and present with gastrointestinal (GI) symptoms. Various nutrition societies have recently published their guidelines in context of the pandemic, and several points emphasize the impact of these GI manifestations on nutrition therapy. In patients with COVID‐19, the normal intestinal mucosa can be disrupted by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) virus, and this could result in GI symptoms and a compromise in nutrient absorption. Optimization of oral diet is still recommended. However, given the GI effects of COVID‐19, a fraction of infected patients have poor appetite and would not be able to meet their nutrition goals with oral diet alone. For this at‐risk group, which includes those who are critically ill, enteral nutrition is the preferred route to promote gut integrity and immune function. In carrying this out, nutrition support practices have been revised in such ways to mitigate viral transmission and adapt to the pandemic. All measures in the GI and nutrition care of patients are clustered to limit exposure of healthcare workers. Among patients admitted to intensive care units, a significant barrier is GI intolerance, and it appears to be exacerbated by significant GI involvement specific to the SARS‐CoV‐2 infection. Nevertheless, several countermeasures can be used to ease side effects. At the end of the spectrum in which intolerance persists, the threshold for switching to parenteral nutrition may need to be lowered.

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Gastrointestinal Complications in Critically Ill Patients With COVID-19

Cited by 181 publications

References 5 publications

Gastrointestinal Complications in Critically Ill Patients With and Without COVID-19

Gastrointestinal Complications in Critically Ill Patients With and Without COVID-19

Case Report: Paralytic Ileus: A Potential Extrapulmonary Manifestation of Severe COVID-19

Gastrointestinal Manifestations of COVID‐19: Impact on Nutrition Practices

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