Management of acute intestinal failure

Abstract

Intestinal failure (IF) occurs when intestinal absorptive function is inadequate to maintain hydration and nutrition without enteral or parenteral supplements. It has been classified into three types depending on duration of nutrition support and reversibility. Type 1 IF is commonly seen in the peri-operative period as ileus and usually spontaneously resolves within 14 d. Type 2 IF is uncommon and is often associated with an intra-abdominal catastrophe, intestinal resection, sepsis, metabolic disturbances and undernutrition. Type 3 IF is a chronic condition in a metabolically stable patient, which usually requires long-term parenteral nutrition. This paper focuses on Types 1 and 2 IF (or acute IF) that are usually found in surgical wards. The objectives of this paper are to review the incidence, aetiology, prevention, management principles and outcome of acute IF. The paper discusses the resources necessary to manage acute IF, the indications for inter-hospital transfer and the practicalities of how to transfer and receive a patient with acute IF.

Single‐Center, Adult Chronic Intestinal Failure Cohort Analyzed According to the ESPEN‐Endorsed Recommendations, Definitions, and Classifications

“…Type 1 IF is defined as the relatively common acute, short‐term, self‐limiting, often perioperative disturbance in intestinal motility (ie, paralytic ileus) and requires PS for a limited period until a full recovery without complications 6 . ‐ 8 Type 2 IF is severe with considerable associated morbidity and mortality, as these patients with IF are unstable with systemic sepsis, metabolic complications, and/or nutrition complications, requiring a prolonged, complex, multidisciplinary intervention with in‐hospital specialized PS 6 , 7 . The European Society of Intensive Care Medicine (ESICM) has further defined and graded the “acute intestinal failure.” 9 Type 3 IF is defined as the chronic, stable patients requiring permanent PS for months/years or even lifelong.…”

Gastrointestinal Dysfunction in Critical Illness: A Review of Scoring Tools

“…43 The IF definition and classification 43 encompasses 2 distinct classifications: (1) "intestinal insufficiency" and (2) "IF," also known as chronic IF. [56][57][58][59][60][61] This distinction does not, however, classify the sequential phases of gut failure since there are no simple indicators to stratify the degree of intestinal dysfunction/failure, or a practical definition to recognize the continuum process of this epiphenomenon.…”

Abdominal wall reconstruction

“…It is innervated and nourished by the intercostal neurovascular bundles (5)(6)(7)(8)(9)(10)(11)(12). It originates from ribs 5-12 and runs in an inferiomedial direction to insert into the linea semilunaris, where it contributes to the anterior rectus sheath, and iliac crest.…”

“…10 Reduction of fistula output may increase the chance of spontaneous closure. These include aggressive treatment of sepsis, nutritional supplementation and attention to fluid and electro lyte disturbances.…”