Gastrointestinal dysmotility in critically ill patients

Abstract

Gastrointestinal (GI) motility disorders are commonly present in critical illness. Up to 60% of critically ill patients have been reported to experience GI dysmotility of some form necessitating therapeutic intervention. It has been attributed to various factors, related to both the underlying disease and the therapeutic interventions undertaken. The assessment of motility disturbances can be challenging in critically ill patients, as the available tests used to detect abnormal motility have major limitations in the setting of an Intensive Care Unit. Critically ill patients with GI dysmotility require a multifaceted treatment approach that addresses multiple causes and utilizes multiple pharmacological pathways. In this review, we discuss the pathophysiology, assessment and management of GI dysmotility in critically ill patients.

Optimal Time and Target for Evaluating Energy Delivery after Adjuvant Feeding with Small Bowel Enteral Nutrition in Critically Ill Patients at High Nutrition Risk

“…Gastrointestinal motility disorder is a common problem among critically ill patients, independent of morbidity and mortality [1,2]. Up to 60% of critically ill patients in intensive care units (ICU) are reported to experience gastrointestinal dysmotility, including delayed gastric emptying, abnormal motility patterns, and impaired intestinal barrier integrity requiring therapeutic intervention [2,3].…”

“…Gastrointestinal motility disorder is a common problem among critically ill patients, independent of morbidity and mortality [1,2]. Up to 60% of critically ill patients in intensive care units (ICU) are reported to experience gastrointestinal dysmotility, including delayed gastric emptying, abnormal motility patterns, and impaired intestinal barrier integrity requiring therapeutic intervention [2,3]. Current guidelines suggest the use of a screening tool such as the nutrition risk in the critically ill (NUTRIC) score or modified NUTRIC score to determine nutrition risk in ICU patients to initiate early enteral nutrition (EN) therapy [4,5,6,7].…”

Elevated intracranial pressure after head trauma can be suppressed by antisecretory factor—a pilot study

“…The uptake of AF for achieving a clinical response after oral administration is dependent on a functioning gastrointestinal passage [20]. In the first two patients in which Salovum® was delivered repeatedly via a nasogastric tube, there was an increased gastric retention of the solution due to gastrointestinal dysmotility which often is present in mechanically ventilated, critically ill patients, especially those with intracranial hypertension receiving opioids for analgesia and sedation [13,18]. This observation is in line with the recent findings by Cederberg et al investigating the effects of AF in patients with severe TBI after nasogastric administration of Salovum® [4].…”

Gastrointestinal Motility Disorders in Critically Ill

“…A common procedure in ICU patients, nasogastric intubation, and impaired salivary clearance are other factors implicated in GERD. 1 , 6 …”

“…There are various diagnostic tests suggested for esophageal dysmotility assessment, such as liquid-esophageal manometry, high-frequency endoluminal ultrasound, multichannel intraluminal impedance, and high-resolution manometry but are of limited use in ICU patients. 6 …”