Gastrointestinal function in critically ill patients

Blaser, Annika Reintam; Bachmann, K; Deane, Adam M.

doi:10.1097/mco.0000000000000955

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

2023

DOI: 10.1097/mco.0000000000000955

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Gastrointestinal function in critically ill patients

Annika Reintam Blaser

K Bachmann

Adam M. Deane

Abstract: Purpose of review To summarize recent evidence regarding the diagnosis of acute gastrointestinal dysfunction and enteral feeding intolerance, and relationship of these to development of multiple organ dysfunction syndrome, during critical illness. Recent findings Novel gastric feeding tubes that attenuate gastroesophageal regurgitation or facilitate continuous monitoring of gastric motility have been developed. The definition of enteral feeding intolera… Show more

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Cited by 4 publications

References 45 publications

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Plasma beta‐hydroxy‐beta‐methylbutyrate availability after enteral administration during critical illness after trauma: An exploratory study

Wittholz,

Bongetti,

Fetterplace

et al. 2024

J Parenter Enteral Nutr

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BackgroundDuring critical illness skeletal muscle wasting occurs rapidly. Although beta‐hydroxy‐beta‐methylbutyrate (HMB) is a potential treatment to attenuate this process, the plasma appearance and muscle concentration is uncertain.MethodsThis was an exploratory study nested within a blinded, parallel group, randomized clinical trial in which critically ill patients after trauma received enteral HMB (3 g daily) or placebo. Plasma samples were collected at 0, 60, and 180 min after study supplement administration on day 1. Needle biopsies of the vastus lateralis muscle were collected (baseline and day 7 of the HMB treatment intervention period). An external standard curve was used to calculate HMB concentrations in plasma and muscle.ResultsData were available for 16 participants (male n = 12 (75%), median [interquartile range] age 50 [29–58] years) who received placebo and 18 participants (male n = 14 (78%), age 49 [34–55] years) who received HMB. Plasma HMB concentrations were similar at baseline but increased after HMB (T = 60 min: placebo 0.60 [0.44–1.31] µM; intervention 51.65 [22.76–64.72] µM). Paired muscle biopsies were collected from 11 participants (placebo n = 7, HMB n = 4). Muscle HMB concentrations were similar at baseline between groups (2.35 [2.17–2.95]; 2.07 [1.78–2.31] µM). For participants in the intervention group who had the repeat biopsy within 4 h of HMB administration, concentrations were greater (7.2 and 12.3 µM) than those who had the repeat biopsy >4 h after HMB (2.7 and 2.1 µM).ConclusionIn this exploratory study, enteral HMB administration increased plasma HMB availability. The small sample size limits interpretation of the muscle HMB findings.

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Plasma beta‐hydroxy‐beta‐methylbutyrate availability after enteral administration during critical illness after trauma: An exploratory study

Wittholz,

Bongetti,

Fetterplace

et al. 2024

J Parenter Enteral Nutr

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Enteral nutrition in septic shock: a call for a paradigm shift

Patel,

Lopez-Delgado,

Stoppe

et al. 2024

Current Opinion in Critical Care

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Purpose of review The purpose of this review is to identify contemporary evidence evaluating enteral nutrition in patients with septic shock, outline risk factors for enteral feeding intolerance (EFI), describe the conundrum of initiating enteral nutrition in patients with septic shock, appraise current EFI definitions, and identify bedside monitors for guiding enteral nutrition therapy. Recent findings The NUTRIREA-2 and NUTRIREA-3 trial results have better informed the dose of enteral nutrition in critically ill patients with circulatory shock. In both trials, patients with predominant septic shock randomized to receive early standard-dose nutrition had more gastrointestinal complications. Compared to other contemporary RCTs that included patients with circulatory shock, patients in the NUTRIREA-2 and NUTRIREA-3 trials had higher bowel ischemia rates, were sicker, and received full-dose enteral nutrition while receiving high baseline dose of vasopressor. These findings suggest severity of illness, vasopressor dose, and enteral nutrition dose impact outcomes. Summary The provision of early enteral nutrition preserves gut barrier functions; however, these benefits are counterbalanced by potential complications of introducing luminal nutrients into a hypo-perfused gut, including bowel ischemia. Findings from the NUTRIREA2 and NUTRIREA-3 trials substantiate a ‘less is more’ enteral nutrition dose strategy during the early acute phase of critical illness. In the absence of bedside tools to guide the initiation and advancement of enteral nutrition in patients with septic shock, the benefit of introducing enteral nutrition on preserving gut barrier function must be weighed against the risk of harm by considering dose of vasopressor, dose of enteral nutrition, and severity of illness.

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Acute gastrointestinal injury: Stages, role in formation and progression of multiple organ failure syndrome, main stages of intensive therapy (literature review)

Machulina,

Shestopalov,

Popova

2023

Medicinskij alfavit

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Acute gastrointestinal injury develops in more than half of all patients in the intensive care unit, regardless of the underlying pathology and it is one of the main reasons for the onset and progression of multiple organ failure and systemic inflammatory response syndrome. The severity of the acute gastrointestinal injury correlates with the risk of death. A deeper understanding of the pathogenetic mechanisms of dysfunction of the gastrointestinal tract in critically ill patients is necessary for the development and implementation of an intensive care regimen that allows to quickly restore the function of the gastrointestinal tract and break the vicious circle of pathophysiological changes, which will ultimately lead to improvement treatment outcomes for critically ill patients and reduced mortality.

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Gastrointestinal function in critically ill patients

Cited by 4 publications

References 45 publications

Plasma beta‐hydroxy‐beta‐methylbutyrate availability after enteral administration during critical illness after trauma: An exploratory study

Plasma beta‐hydroxy‐beta‐methylbutyrate availability after enteral administration during critical illness after trauma: An exploratory study

Enteral nutrition in septic shock: a call for a paradigm shift

Acute gastrointestinal injury: Stages, role in formation and progression of multiple organ failure syndrome, main stages of intensive therapy (literature review)

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