Intra-Abdominal Hypertension and Gastrointestinal Symptoms in Mechanically Ventilated Patients

Blaser, Annika Reintam; Parm, Pille; Kitus, Reet; Starkopf, Joel

doi:10.1155/2011/982507

Cited by 14 publications

(10 citation statements)

References 13 publications

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“…Combining enteral diet tolerance and IAP values, Reintam et al (23) developed a GI failure score with prognostic value for ICU mortality. In that study the authors did not assess the possible link between IAP and EN tolerance, though in a later trial [27], they reported no such relationship. However, they did note that patients with both high IAP and signs of diet intolerance had worse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Intra-Abdominal Pressure as a Marker of Enteral Nutrition Intolerance in Critically Ill Patients. The PIANE Study

et al. 2019

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To determine whether elevated intra-abdominal pressure (IAP) is associated with a higher rate of enteral nutrition-related gastrointestinal (GI) complications; to assess the value of IAP as a predictor of enteral nutrition (EN) intolerance. Intensive Care Unit (ICU) patients on mechanical ventilation requiring at least 5 days of EN were recruited for a prospective, observational, non-interventional, multicenter study. EN was performed and GI complications were managed with an established protocol. IAP was determined via a urinary catheter. Patients who developed any GI complications were considered as presenting EN intolerance. Variables related to EN, IAP and GI complications were monitored daily. Statistical analysis compared patients without GI complications (group A) vs. GI complications (group B). 247 patients were recruited from 28 participating ICUs (group A: 119, group B: 128). No differences between groups were recorded. Patients in group B (p < 0.001) spent more days on EN (8.1 ± 8.4 vs. 18.1 ± 13.7), on mechanical ventilation (8.0 ± 7.7 vs. 19.3 ± 14.9) and in the ICU (12.3 ± 11.4 vs. 24.8 ± 17.5). IAP prior to the GI complication was (14.3 ± 3.1 vs. 15.8 ± 4.8) (p < 0.003). The best IAP value identified for EN intolerance was 14 mmHg but it had low sensitivity and specificity. Although a higher IAP was associated with EN intolerance, IAP alone did not emerge as a good predictor of EN intolerance in critically ill patients.

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Section: Discussionmentioning

confidence: 99%

Intra-Abdominal Pressure as a Marker of Enteral Nutrition Intolerance in Critically Ill Patients. The PIANE Study

et al. 2019

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“…However, gastrointestinal dysfunction can lead to IAH and vice versa. IAP is not a direct indicator of gastrointestinal function, which may confuse the relationship between gastrointestinal symptoms and IAP [37]. In that sense, intestinal ultrasonography has certain advantages over other methods used previously by practitioners.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of transabdominal intestinal sonography in critically ill patients: a prospective observational study

Gao

Chen

et al. 2019

Crit Care

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BackgroundThis study examined the feasibility of transabdominal intestinal ultrasonography in evaluating acute gastrointestinal injury (AGI).MethodsA total of 116 patients were included. Intestinal ultrasonography was conducted daily within 1 week after admission to the intensive care unit. Ultrasonography indicators including intestinal diameter, changes in the intestinal folds, thickness of the intestinal wall, stratification of the intestinal wall, and intestinal peristalsis (movement of the intestinal contents) were observed to determine the acute gastrointestinal injury ultrasonography (AGIUS) score. The gastrointestinal and urinary tract sonography ultrasound (GUTS) protocol score was also calculated. During the first week of the study, the gastrointestinal failure (GIF) score was determined daily. The correlations between transabdominal intestinal scores (AGIUS and GUTS) and the GIF score were analyzed to clarify the feasibility of evaluating AGI through observation of the intestine. The utility of intestinal ultrasonography indicators in predicting feeding intolerance was investigated to improve the ability of clinicians to manage AGI.ResultsA total of 751 ultrasonic examinations were performed with 511 images (68%) considered to be of “good quality.” AGIUS and GUTS scores differed significantly between AGI patients (GIF score 0–2) and non-AGI patients (GIF score 3–4) (p < 0.001). Both scores correlated positively with GIF score (r = 0.54, p < 0.001; r = 0.66, p < 0.001). These ultrasonography indicators could predict feeding intolerance, with an area under the receiver operating characteristic curve of 0.60 (0.48–0.71; intestinal diameter), 0.76 (0.67–0.85; intestinal folds), 0.71 (0.62–0.80; wall thickness), 0.77 (0.69–0.86; wall stratification), and 0.78 (0.68–0.88; intestinal peristalsis). Compared to patients with a normal rate of peristalsis (5–10/min), patients with abnormal peristalsis rates (< 5/min or > 10/min) have increased risk for feeding intolerance (16/83 vs. 25/33, p < 0.001).ConclusionsThe transabdominal intestinal ultrasonography represents an effective means for assessing gastrointestinal injury in critically ill patients. Intestinal ultrasonography indicators, especially the degree of intestinal peristalsis, may be used to predict feeding intolerance.Trial registrationClinicalTrial.gov, NCT03589248. Registered 04 July 2018—retrospectively registered.

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“…The definition of intraabdominal hypertension (IAH) and measurement of IAP is described elsewhere [27]. In a study in mechanically ventilated patients, the presence of IAH in the absence of GI symptoms was not associated with mortality [28].…”

Section: Other Monitoring Optionsmentioning

confidence: 99%

Gastrointestinal dysfunction in the critically ill: a systematic scoping review and research agenda proposed by the Section of Metabolism, Endocrinology and Nutrition of the European Society of Intensive Care Medicine

Blaser¹,

Preiser²,

Fruhwald³

et al. 2020

Crit Care

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127

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Background: Gastrointestinal (GI) dysfunction is frequent in the critically ill but can be overlooked as a result of the lack of standardization of the diagnostic and therapeutic approaches. We aimed to develop a research agenda for GI dysfunction for future research. We systematically reviewed the current knowledge on a broad range of subtopics from a specific viewpoint of GI dysfunction, highlighting the remaining areas of uncertainty and suggesting future studies. Methods: This systematic scoping review and research agenda was conducted following successive steps: (1) identify clinically important subtopics within the field of GI function which warrant further research; (2) systematically review the literature for each subtopic using PubMed, CENTRAL and Cochrane Database of Systematic Reviews; (3) summarize evidence for each subtopic; (4) identify areas of uncertainty; (5) formulate and refine study proposals that address these subtopics; and (6) prioritize study proposals via sequential voting rounds.

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Intra-Abdominal Hypertension and Gastrointestinal Symptoms in Mechanically Ventilated Patients

Cited by 14 publications

References 13 publications

Intra-Abdominal Pressure as a Marker of Enteral Nutrition Intolerance in Critically Ill Patients. The PIANE Study

Intra-Abdominal Pressure as a Marker of Enteral Nutrition Intolerance in Critically Ill Patients. The PIANE Study

Predictive value of transabdominal intestinal sonography in critically ill patients: a prospective observational study

Gastrointestinal dysfunction in the critically ill: a systematic scoping review and research agenda proposed by the Section of Metabolism, Endocrinology and Nutrition of the European Society of Intensive Care Medicine

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