Gastroparesis in the intensive care unit

Stojek, Magdalena; Jasiński, Tomasz

doi:10.5114/ait.2021.110959

Cited by 6 publications

(19 citation statements)

References 43 publications

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“…It is estimated that at least 60% of ICU patients are affected by some form of GI dysfunction and that in 30% of patients in whom EN is attempted the feeding route needs to be modi ed to PN route because of not achieving prescribed nutrient provision or the occurrence of GI complications or both [17]. In our study, the use of PN was related to paralytic ileus or the inability to fully tolerate EN accounted for the impossibility of achieving adequate and su cient nutritional requirements with EN alone.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, some ICU patients are not able to tolerate prescribed EN due to the occurrence of gastrointestinal (GI) complications (e.g., high gastric residual volumes, diarrhea, vomiting), leading to the lack of optimal nutrient provision [15,16]. In consequence, this suboptimal nutrition intake may worsen nutritional status, which is associated with higher complications (e.g., infections) and higher mortality [17]. The occurrence of GI complications and EN intolerance is closely related with GI dysfunction and adverse outcomes [17].…”

Section: Introductionmentioning

confidence: 99%

“…In consequence, this suboptimal nutrition intake may worsen nutritional status, which is associated with higher complications (e.g., infections) and higher mortality [17]. The occurrence of GI complications and EN intolerance is closely related with GI dysfunction and adverse outcomes [17]. The use of PN after the initiation of EN could help to improve nutritional intake and mitigate the development of malnutrition in ICU patients [18].…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with the need of Parenteral Nutrition in Critically Ill patients with Enteral Nutrition Therapy

López-Delgado

Grau-Carmona

Bordeje-Laguna

et al. 2022

Preprint

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Background: Enteral nutrition (EN) is the preferred route of nutrition in the critically ill patients. However, EN is not always able to provide optimal nutrient provision and parenteral nutrition (PN) is needed. We examined factors associated with the need of PN after start of EN, together with the use and complications associated with EN.Methods: Adult patients admitted to 38 Spanish intensive care units (ICUs) between April and July 2018, who needed EN therapy were included in a prospective observational study. The characteristics of EN-treated patients and those who required PN after start EN were analyzed.Results: Of a total of 443 patients, 43 (9.7%) received PN. One-third (29.3%) of patients presented EN-related complications, which were more frequent among those needing PN (26% vs. 60%, P=0.001). No differences regarding mean energy and protein delivery were found between patients treated only with EN and those needing supplementary or total PN. Abnormalities in lipid profile, blood proteins, and inflammatory markers, such as C-Reactive Protein, were showed in those patients needing PN. Sequential Organ Failure Assessment (SOFA) on ICU admission (Hazard ratio [HR]:1.161, 95% confidence interval [CI].1.053-1.281, P=0.003) and modified Nutrition Risk in Critically Ill (mNUTRIC) score (HR:1.311, 95% CI:1.098-1.565, P=0.003) were higher among those who needed PN. In the multivariate analysis, higher SOFA score (HR:1.221, 95% CI:1.057-1.410, P=0.007) and higher triglyceride levels on ICU admission (HR:1.004, 95% CI:1.001-1.007, P=0.003) were associated with an increased risk for the need of PN, whereas higher albumin levels on ICU admission (HR:0.424, 95% CI:0.210-0.687, P=0.016) was associated with lower need of PN.Conclusion: Higher SOFA and nutrition-related laboratory parameters on ICU admission may be associated with the need of PN after starting EN therapy. This may ultimately be related with the occurrence of gastro-intestinal dysfunction, severe inflammatory response, and disease severity. Trial registration: The Evaluation of Nutritional Practices In the Critical Care Patient (ENPIC) Study was registered at ClinicalTrials.gov (NCT03634943). Retrospectively registered on 17 August 2018.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors associated with the need of Parenteral Nutrition in Critically Ill patients with Enteral Nutrition Therapy

López-Delgado

Grau-Carmona

Bordeje-Laguna

et al. 2022

Preprint

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“…However, its reliability is controversial, depending on lack of diagnostic standardization, different aspiration techniques, body position of patient, diameter of tubes, etc. 24 Sharma et al 8 found that GRV was strongly correlated with antral CSA and indicated the diagnostic value of CC diameter <10 mm for <500 ml GRV in 19 critically ill patients. Similar to our study, Taskin et al reported that ultrasound examination of gastric antral CSA allows feasible and reliable estimation of GRV in 56 critically ill patients receiving EN feeding.…”

Section: Hamada Et Al Reported That Ultrasonographic Measurement Of G...mentioning

confidence: 99%

Gastric ultrasound, citrulline, and intestinal fatty acid–binding protein as markers of gastrointestinal dysfunction in critically ill patients: A pilot prospective cohort study

Onuk

Özer

Özel

et al. 2023

J Parenter Enteral Nutr

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Background: Gastrointestinal (GI) dysfunction is common in the intensive care unit (ICU), although there is no consensus on biomarkers of GI dysfunction. We aimed to evaluate ultrasound-based gastric antrum measurements and serum intestinal fatty acid-binding protein (IFABP) and citrulline levels in relation to GI dysfunction in critically ill patients.Methods: Adult critically ill patients receiving enteral nutrition and stayed for in the ICU for ≥48 h was included. GI dysfunction was described using Gastrointestinal Dysfunction Score (GIDS). Gastric antrum measurements, including craniocaudal (CC) diameter, anteroposterior diameter, and antral-cross sectional area (CSA), as well as serum levels for IFABP and citrulline, were prospectively recorded at baseline and on day 3 and day 5 of enteral nutrition. The receiver operating characteristic (ROC) analysis was performed to evaluate gastric ultrasound parameters, serum IFABP, and citrulline concentrations in predicting GI dysfunction.Results: Thirty-nine participants with a median age of 60 years were recruited and 46.2% of participants had GI dysfunction. ROC analysis revealed that the cutoff value of CSA score to predict GI dysfunction was 4.48 cm 2 , which provided 72.7% sensitivity and 77.2% specificity (area under the curve = 0.768, 95% CI: 0.555-0.980). At baseline, gastric residual volume was highly correlated with CC diameter and CSA (r = 0.764, P < 0.001 and r = 0.675, P < 0.001, respectively). Serum IFABP and citrulline levels had no correlation with GI dysfunction or gastric ultrasound parameters (P > 0.05). Conclusion:CSA was associated with GI dysfunction in critically ill patients. Serum IFABP and citrulline concentrations were poor in predicting GI dysfunction.

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“…Gastric emptying scintigraphy is a time-consuming test and is not widely used in practice for diagnosing gastroparesis in critically ill patients [ 40 ]. Paracetamol absorption is another technique that can be used for gastric emptying assessment [ 41 ].…”

Section: Reviewmentioning

confidence: 99%

Diagnostic Modalities Used in Diagnosing Gastroparesis: A Clinical Review

Ghazanfar¹,

Allena²,

Javed³

et al. 2022

Cureus

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Gastroparesis is associated with abnormal gastric motility characterized by delayed gastric emptying without any obvious mechanical gastric outlet obstruction or blockage. Gastroparesis is associated with significant morbidity and mortality. It is pertinent to make a timely diagnosis of gastroparesis so that prompt treatment can be initiated. The purpose of this clinical review article is to help the internist and the primary care providers to get a better idea of various diagnostic modalities used in diagnosing gastroparesis. We have also discussed the advantages and disadvantages of various diagnostic modalities based on the latest evidence.

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Gastroparesis in the intensive care unit

Cited by 6 publications

References 43 publications

Factors associated with the need of Parenteral Nutrition in Critically Ill patients with Enteral Nutrition Therapy

Factors associated with the need of Parenteral Nutrition in Critically Ill patients with Enteral Nutrition Therapy

Gastric ultrasound, citrulline, and intestinal fatty acid–binding protein as markers of gastrointestinal dysfunction in critically ill patients: A pilot prospective cohort study

Diagnostic Modalities Used in Diagnosing Gastroparesis: A Clinical Review

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