Are Classic Bedside Exam Findings Required to Initiate Enteral Nutrition in Critically Ill Patients: Emphasis on Bowel Sounds and Abdominal Distension

Abstract

The general physical examination of a patient is an axiom of critical care medicine, but evidence to support this practice remains sparse. Given the lack of evidence for a comprehensive physical examination of the entire patient on admission to the intensive care unit, which most clinicians consider an essential part of care, should clinicians continue the practice of a specialized gastrointestinal system physical examination when commencing enteral nutrition in critically ill patients? In this review of literature related to gastrointestinal system examination in critically ill patients, the focus is on gastrointestinal sounds and abdominal distension. There is a summary of what these physical features represent, an evaluation of the evidence regarding use of these physical features in patients after abdominal surgery, exploration of the rationale for and against using the physical findings in routine practice, and detail regarding what is known about each feature in critically ill patients. Based on the available evidence, it is recommended that an isolated symptom, sign, or bedside test does not provide meaningful information. However, it is submitted that a comprehensive physical assessment of the gastrointestinal system still has a role when initiating or administering enteral nutrition: specifically, when multiple features are present, clinicians should consider further investigation or intervention.

Current practice of gastric residual volume measurements and related outcomes of critically ill patients: A secondary analysis of the intestinal‐specific organ function assessment study

“…High GRV reflects only one aspect of GI dysfunction, whereas the combination with other GI symptoms is probably more meaningful. 5,12,13,22 The prospectively developed GastroIntestinal Dysfunction Score (GIDS) using several markers of GI dysfunction was established based on the main iSOFA study. 11 Notably, all components of the GIDS, including high GRV, appeared important, indicating that cooccurrence of high GRV with other GI symptoms is associated with increased mortality.…”

Bedside gastrointestinal ultrasound combined with acute gastrointestinal injury score to guide enteral nutrition therapy in critically patients

“…In IAP similar states, although circulation is stable, some patients do not have synchronous recovery of intestinal function [ 8 ]. This phenomenon is not reflected by abdominal examination and IAP [ 20 ]. It indicates that gastrointestinal ultrasound can better evaluate the damage state of gastrointestinal function, and enteral nutrition therapy can be carried out earlier [ 21 ].…”

Practicing Digital Gastroenterology through Phonoenterography Leveraging Artificial Intelligence: Future Perspectives Using Microwave Systems

“…Another study also observed some ICU patients with ileus showing the presence of bowel sounds instead of absence [ 71 ]. Thus, the discrepancies in literature and technical difficulties encourage the need for further research on pathophysiology and recording technologies [ 72 ].…”