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Mechanisms underlying feed intolerance in the critically ill: implications for treatment
World Journal of Gastroenterology
|August 1, 2007
Summary
Critically ill patients often experience delayed gastric emptying, hindering early enteral nutrition. Current methods to assess this are unclear, but pharmacological treatments show promise.
Area of Science:
- Critical care medicine
- Gastroenterology
- Nutritional science
Background:
- Early enteral feeding is crucial for critically ill patients, but delayed gastric emptying frequently limits its efficacy.
- The clinical identification of delayed gastric emptying and feeding intolerance lacks standardized, reliable methods.
- Gastric residual volume (GRV) is a commonly used but increasingly debated marker for gastric emptying in critical illness.
Discussion:
- Understanding the pathophysiology of delayed gastric emptying is essential for developing effective interventions.
- Pharmacological strategies, including intravenous metoclopramide and erythromycin, show potential for improving enteral feeding success.
- Novel therapeutic agents and simpler methods for distal small bowel feeding are under investigation.
Key Insights:
- Delayed gastric emptying is a significant barrier to optimal nutritional support in critical illness.
- Current diagnostic tools for feed intolerance are insufficient, necessitating further research into reliable markers.
- Combination therapy with metoclopramide and erythromycin appears effective, but new drug therapies are needed.
Outlook:
- Further research into the mechanisms of delayed gastric emptying is required.
- Development of novel pharmacological agents and innovative feeding techniques is crucial.
- Standardization of methods for assessing gastric emptying and feed intolerance will improve patient outcomes.
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