Gastric emptying in the critically ill patient

Area of Science:

• Critical Care Medicine
• Gastroenterology
• Clinical Nutrition

Background:

• Gastric dysmotility is a frequent complication in critically ill patients.
• This condition often impedes the timely initiation and efficacy of enteral nutrition.
• While jejunal feeding bypasses gastric issues, its insertion can be challenging.

Purpose of the Study:

• To review the pathophysiology of gastroparesis.
• To present a practical management approach for gastroparesis in critically ill patients.

Main Methods:

• Review of articles and published abstracts on gastroparesis mechanisms and management.
• Focus on relevance to the critically ill patient population.

Main Results:

• Gastric dysmotility is multifactorial, influenced by sepsis, pain, hypotension, dehydration, and hyperglycemia.
• Avoidance of opiates and dopamine is recommended before prokinetic therapy.
• Prokinetic agents like cisapride or erythromycin, along with head elevation, can facilitate enteral feeding.

Conclusions:

• Gastric dysmotility is prevalent in critically ill patients.
• Effective management involves treating underlying conditions and employing prokinetic agents.
• Successful enteral nutrition is achievable for most patients with appropriate interventions.