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Assessment of Gastric Emptying in Non-obese Diabetic Mice Using a [13C]-octanoic Acid Breath Test
Published on: March 23, 2013
Delayed gastric emptying in ventilated critically ill patients: measurement by 13 C-octanoic acid breath test
M A Ritz1, R Fraser, N Edwards
1Department of Gastrointestinal Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Objective:
To measure gastric emptying in ventilated critically ill patients with a new noninvasive breath test.
Design:
Single-center, open study.
Setting:
Combined medical and surgical intensive care unit of a university hospital.
Subjects:
Thirty unselected mechanically ventilated critically ill patients receiving gastric feeding and 22 healthy volunteers.
Interventions:
None.
Patients:
After 4 hrs without feeding, intragastric infusion of 100 mL of a liquid meal (Ensure) labeled with 100 microL 13C-octanoic acid. End-expiratory breath samples were collected into evacuated tubes from the respirator circuit every 5 mins for the first hour, then every 15 mins for 3 hrs. End-expiratory breath samples were also collected from volunteers studied supine after an overnight fast following an identical infusion via a nasogastric tube. Breath 13CO2 was measured with an isotope ratio mass spectrometer.
Measurements And Main Results:
Performance of the breath test posed no difficulty or interference with patient care. The CO2 level was >1% in 1297/1300 breath samples, indicating satisfactory end-expiratory timing. Data are median and interquartile range. Gastric emptying was slower in patients compared with volunteers: gastric emptying coefficient 2.93 (2.17-3.39) vs. 3.58 (3.18-3.79), p <.001 and gastric half emptying time, derived from the area under the 13CO2 curve, 155 min (130-220) vs. 133 min (120-145), p <.008. Fourteen of the 30 patients had a gastric emptying coefficient <95% of all volunteers and 11 had a gastric half emptying time longer than 95% of all volunteers. The Acute Physiology and Chronic Health Evaluation (APACHE II) score (median 22, range 13-43) either at admission or on the day of the study did not correlate with gastric emptying coefficient.
Conclusion:
Gastric emptying of a calorie-dense liquid meal is slow in 40% to 45% of unselected mechanically ventilated patients in a combined medical and surgical intensive care unit. The 13C-octanoic acid breath test is a novel and useful bedside technique to measure gastric emptying in these patients.
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