Gastrointestinal failure in intensive care: a retrospective clinical study in three different intensive care units in Germany and Estonia

Abstract

BackgroundWhile gastrointestinal problems are common in ICU patients with multiple organ failure, gastrointestinal failure has not been given the consideration other organ systems receive. The aim of this study was to evaluate the incidence of gastrointestinal failure (GIF), to identify its risk factors, and to determine its association with ICU mortality.MethodsA retrospective analysis of adult patients (n = 2588) admitted to three different ICUs (two ICUs at the university hospital Charité-Universitätsmedizin Berlin, Germany and one at Tartu University Clinics, Estonia) during the year 2002 was performed.Data recorded in a computerized database were used in Berlin. In Tartu, the data documented in the patients' charts was retrospectively transferred into a similar database. GIF was defined as documented gastrointestinal problems (food intolerance, gastrointestinal haemorrhage, and/or ileus) in the patient data at any period of their ICU stay. ICU mortality, length of stay, and duration of mechanical ventilation were assessed as outcome parameters.ResultsGIF was identified in 252 patients (9.7% of all patients). Only 20% of GIF patients were identifiable at admission. GIF was related to significantly higher mortality (43.7% vs. 5.3% in patients without GIF), as well as prolonged length of ICU stay (10 vs. 2 days) and mechanical ventilation (8 vs. 1 day), p < 0.001, respectively. Patients' profile (emergency surgical or medical), APACHE II and SOFA scores and the use of catecholamines at admission were identified as independent risk factors for the development of GIF. Development of GIF during ICU stay was an independent predictor for death.ConclusionGastrointestinal failure represents a relevant clinical problem accompanied by an increased mortality, longer ICU stay and mechanical ventilation.

Risk of aspiration in patients on enteral nutrition: Frequency, relevance, relation to pneumonia, risk factors, and strategies for risk reduction

“…This syndrome is more commonly observed in patients with acute medical and surgical emergencies than in patients undergoing elective surgery and typically develops several days after admission to an ICU. In a recent retrospective study of ICU patients, incidence of GIF was approximately 10%; development of GIF during ICU stay was found to be an independent risk factor for death [26].…”

Addressing Concerns about Changing the Route of Antimicrobial Administration from Intravenous to Oral in Adult Inpatients

“…Other clues to possible impaired absorption, which are not necessarily limited to critically ill patients, include food intolerance (e.g., vomiting), intolerance of feeding by nasogastric tube (as suggested by high aspirate volumes), gastrointestinal hemorrhage, or ileus. 51 As well, patients undergoing chemotherapy and those with severe oral mucositis may have impaired gut function.…”

Methylnaltrexon

“…Trotz ihrer hohen Prävalenz gehört die Obstipa tion zu jenen Nebenwirkungen der Opioid therapie, die vom medizinischen Fachper sonal am meisten unterschätzt und am häufigsten übersehen werden [30]. Hier auf basierende weitere Komplikationen, die sich bis zum paralytischen Ileus ent wickeln können, werden allerdings nicht nur durch die Opioide allein bedingt, son dern werden verstärkt durch begleitende Probleme wie Dehydrierung, verringerte Nahrungsmittelaufnahme oder Immobi lisierung [28].…”