Prevalence, Risk Factors, Clinical Consequences, and Treatment of Enteral Feed Intolerance During Critical Illness

Gungabissoon, Usha; Hacquoil, Kimberley; Bains, Chanchal; Irizarry, Michael C.; Dukes, George E.; Williamson, Russell; Deane, Adam M.; Heyland, Daren K.

doi:10.1177/0148607114526450

Cited by 196 publications

(261 citation statements)

References 21 publications

(34 reference statements)

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“…Despite the problems with definition, current evidence supports the concept that FI occurs frequently and is associated with adverse outcomes in critically ill patients. In an international observational cohort study of 1888 ICU patients, the frequency of FI (defined as GRV ≥200 ml) was 30.5% and was associated with worse nutrition adequacy (56% vs. 64%, P < 0.0001), increased ICU stay (14.4 vs. 11.3 days, P < 0.0001), and increased mortality (30.8% vs. 26.2%, P = 0.04) [8]. In a retrospective observational study, Reintam et al observed that the frequency of FI and the association between FI and mortality varied widely and depended on the definition used.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the problems with definition, FI has been suggested to occur frequently and to be associated with adverse outcomes in critically ill patients [1, 6]. Nevertheless, the exact role of FI with regard to mortality remains controversial [8–11]. It is uncertain whether FI simply represents an epiphenomenon of illness severity or harm from inadequate enteral nutrition (EN) and/or the use of parenteral nutrition [12].…”

Section: Introductionmentioning

confidence: 99%

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Severity of acute gastrointestinal injury grade is a predictor of all-cause mortality in critically ill patients: a multicenter, prospective, observational study

Sun

et al. 2017

Crit Care

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BackgroundIn 2012, the European Society of Intensive Care Medicine proposed a definition for acute gastrointestinal injury (AGI) based on current medical evidence and expert opinion. The aim of the present study was to evaluate the feasibility of using the current AGI grading system and to investigate the association between AGI severity grades with clinical outcome in critically ill patients.MethodsAdult patients at 14 general intensive care units (ICUs) with an expected ICU stay ≥24 h were prospectively studied. The AGI grade was assessed daily on the basis of gastrointestinal (GI) symptoms, intra-abdominal pressures, and feeding intolerance (FI) in the first week of admission to the ICU.ResultsAmong the 550 patients enrolled, 456 patients (82.9%) received mechanical ventilation, and 470 patients were identified for AGI. The distribution of the global AGI grade was 24.5% with grade I, 49.4% with grade II, 20.6% with grade III, and 5.5% with grade IV. AGI grading was positively correlated with 28- and 60-day mortality (P < 0.0001). Univariate Cox regression analysis showed that age, sepsis, diabetes mellitus, coronary artery disease, the use of vasoactive drugs, serum creatinine and lactate levels, mechanical ventilation, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and the global AGI grade were significantly (P ≤ 0.02) associated with 60-day mortality. In a multivariate analysis including these variables, diabetes mellitus (HR 1.43, 95% CI 1.03–1.87; P = 0.05), the use of vasoactive drugs (HR 1.56, 95% CI 1.12–2.11; P = 0.01), serum lactate (HR 1.15, 95% CI 1.06–1.24; P = 0.03), global AGI grade (HR 1.65, 95% CI 1.28–2.12; P = 0.008), and APACHE II score (HR 1.04, 95% CI 1.02–1.06; P < 0.001) were independently associated with 60-day mortality. In a subgroup analysis of 402 patients with 7-day survival, in addition to clinical predictors and the AGI grade on the first day of ICU stay, FI within the first week of ICU stay had an independent and incremental prognostic value for 60-day mortality (χ2 = 41.9 vs. 52.2, P = 0.007).ConclusionsThe AGI grading scheme is useful for identifying the severity of GI dysfunction and could be used as a predictor of impaired outcomes. In addition, these results support the hypothesis that persistent FI within the first week of ICU stay is an independent determinant for mortality.Trial registrationChinese Clinical Trial Registry identifier: ChiCTR-OCS-13003824. Registered on 29 September 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1780-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Severity of acute gastrointestinal injury grade is a predictor of all-cause mortality in critically ill patients: a multicenter, prospective, observational study

Sun

et al. 2017

Crit Care

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“…Effective enteral nutrition, however, requires functioning gastrointestinal tract, often missing in the critically ill patient [24]. The factors neces-sary for the maintenance of the physiological structure and mucosal perfusion (Figure 1), are often compromised due to circulatory disturbances in patients in an ICU.…”

Section: The Correlation Between Gastric Mucosal Perfusion and Emptyimentioning

confidence: 99%

Recent Advances Of Mucosal Capnometry And The Perspectives Of Gastrointestinal Monitoring In The Critically Ill. A Pilot Study

Palágyi

Barna

Csábi

et al. 2016

The Journal of Critical Care Medicine

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Mucosal capnometry involves the monitoring of partial pressure of carbon dioxide (PCO2) in mucous membranes. Different techniques have been developed and applied for this purpose, including sublingual or buccal sensors, or special gastrointestinal tonometric devices. The primary use of these procedures is to detect compensated shock in critically ill patients or patients undergoing major surgery. Compensatory mechanisms, in the early phases of shock, lead to the redistribution of blood flow towards the vital organs, within ostensibly typical macro-haemodynamic parameters. Unfortunately, this may result in microcirculatory disturbances, which can play a pivotal role in the development of organ failure. In such circumstances mucosal capnometry monitoring, at different gastrointestinal sites, can provide a sensitive method for the early diagnosis of shock. The special PCO2 monitoring methods assess the severity of ischaemia and help to define the necessary therapeutic interventions and testing of these monitors have justified their prognostic value. Gastrointestinal mucosal capnometry monitoring also helps in determining the severity of ischaemia and is a useful adjunctive in the diagnosis of occlusive splanchnic arterial diseases. The supplementary functional information increases the diagnostic accuracy of radiological techniques, assists in creating individualized treatment plans, and helps in follow-up the results of interventions. The results of a pilot study focusing on the interrelation of splanchnic perfusion and gastrointestinal function are given and discussed concerning recent advances in mucosal capnometry.

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“…However, the defi nition of intolerance is variable. The incidence of interrupted EN therapy due to intolerance was 30.5 % in a cohort of 1888 ICU patients in the 2009 International Nutrition Study [ 38 ]. The most commonly reported intolerances were large gastric residual volumes (61.6 %) and vomiting or diarrhea (36.6 %).…”

Section: Delays and Obstacles To Feeding In Critical Carementioning

confidence: 99%

Assessment of the Patient

Winkler

Lynch

Lueckel

2016

Nutrition Support for the Critically Ill

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Prevalence, Risk Factors, Clinical Consequences, and Treatment of Enteral Feed Intolerance During Critical Illness

Abstract: Intolerance occurs frequently during EN in critically ill patients and is associated with poorer nutrition and clinical outcomes.

Cited by 196 publications

References 21 publications

Severity of acute gastrointestinal injury grade is a predictor of all-cause mortality in critically ill patients: a multicenter, prospective, observational study

Severity of acute gastrointestinal injury grade is a predictor of all-cause mortality in critically ill patients: a multicenter, prospective, observational study

Recent Advances Of Mucosal Capnometry And The Perspectives Of Gastrointestinal Monitoring In The Critically Ill. A Pilot Study

Assessment of the Patient

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