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

Abstract

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.

Gastrointestinal failure score in children with traumatic brain injury

“…Stress ulcers were diagnosed if dark blood fluid was found in gastrointestinal decompression tubes or gastric and duodenal mucosa erosion and ulcers were observed by gastroscopy. The criteria for FI diagnosis were failed enteral feeding or vomiting after eating more than three times a day, gastric residual volumes exceeding 50 % of the feeding volume, and intestinal obstruction, severe diarrhea, or bloating that could not be resolved within 24 h. If FI developed, intra-abdominal pressure (IAP) was measured with an empty bladder in the supine position using the closed-loop system repeated-measurements technique [9]. IAP was measured at least twice per day when normal.…”

Gastrointestinal Failure Score in Children with Traumatic Brain Injury

“…Enteral feeding was provided as early as possible. The criteria for FI diagnosis were failed enteral feeding or vomiting after eating more than 3 times a day, gastric residual volumes exceeding 50% of the feeding volume, and intestinal obstruction, severe diarrhea, or bloating that could not be resolved with 24 h. If FI developed, intra-abdominal pressure (IAP) was measured with an empty bladder in the supine position using the closed loop system repeated measurements technique [9]. IAP was measured at least twice per day when normal.…”

Gastrointestinal Failure Score in Children with Traumatic Brain Injury

“…Stress ulcer was diagnosed if dark blood uid was found in gastrointestinal decompression tube or gastric and duodenal mucosa erosion and ulcer were observed by gastroscopy. The criteria for FI diagnosis were failed enteral feeding or vomiting after eating more than 3 times a day, gastric residual volumes exceeding 50% of the feeding volume, and intestinal obstruction, severe diarrhea, or bloating that could not be resolved with 24 h. If FI developed, intra-abdominal pressure (IAP) was measured with an empty bladder in the supine position using the closed loop system repeated measurements technique [9]. IAP was measured at least twice per day when normal.…”

“…The criteria for the diagnosis of FI were failure of enteral feeding or occurrence of recurrent vomiting, high gastric residual volumes, intestinal obstruction, severe diarrhea, abdominal pain, or bloating that could not be resolved. Intra-abdominal pressure (IAP) was measured via empty bladder in the supine position, using the closed loop system repeated measurements technique when the child developed FI [7] . The IAP was measured at least twice per day when normal.…”