Gastric Dysmotility in Critically Ill Children: Pathophysiology, Diagnosis, and Management
Enid E Martinez1, Katherine Douglas, Samuel Nurko
11Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA. 2Harvard Medical School, Boston, MA. 3School of Arts and Sciences, Providence College, Providence, RI. 4Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA.
Insights
Gastric dysmotility affects up to 50% of critically ill children, leading to poor outcomes. Current diagnostic tools and therapies for delayed gastric emptying are limited, necessitating further research.
Area of Science:
- Pediatric critical care medicine
- Gastroenterology
- Pharmacology
Background:
- Gastric dysmotility is a frequent complication in critically ill children, impacting patient safety and outcomes.
- Delayed gastric emptying (DGE) affects up to 50% of these patients, potentially causing aspiration, ventilator-associated pneumonia, and inadequate enteral nutrition.
- Critical illness and its treatments significantly influence gastric motility.
Purpose of the Study:
- To review the pathophysiology of gastric dysmotility in critically ill children.
- To examine diagnostic methodologies for gastric emptying.
- To explore current and potential future therapies for gastric dysmotility.
Main Methods:
- A literature search was conducted on PubMed and MEDLINE for studies published since 1995.
- Key terms included "gastric emptying," "gastric motility/dysmotility," "gastrointestinal motility/dysmotility," "nutrition intolerance," and "gastric residual volume."
- Studies were reviewed for physiology, pathophysiology, diagnostics, and therapies related to gastric emptying.
Main Results:
- Delayed gastric emptying is common in critically ill children and linked to adverse outcomes.
- Current bedside diagnostic tools for gastric emptying are not well-studied in this population.
- Gastric residual volume measurements may be inaccurate indicators of DGE.
Conclusions:
- Gastric dysmotility is prevalent in critically ill children but poorly understood and inadequately defined.
- Existing therapies for DGE are limited and lack robust evidence.
- Further investigation into gastric motility, accurate bedside diagnostics, and novel therapies is crucial.
Objective:
We aimed to review gastric dysmotility in critically ill children: 1) its pathophysiology, with a focus on critical care diseases and therapies that affect gastric motility, 2) diagnostic methodologies, and 3) current and future potential therapies.
Data Sources:
Eligible studies were identified from PubMed and MEDLINE.
Study Selection:
Literature search included the following key terms: "gastric emptying," "gastric motility/dysmotility," "gastrointestinal motility/dysmotility," "nutrition intolerance," and "gastric residual volume."
Data Extraction:
Studies since 1995 were extracted and reviewed for inclusion by the authors related to the physiology, pathophysiology, diagnostic methodologies, and available therapies for gastric emptying.
Data Synthesis:
Delayed gastric emptying, a common presentation of gastric dysmotility, is present in up to 50% of critically ill children. It is associated with the potential for aspiration, ventilator-associated pneumonia, and inadequate delivery of enteral nutrition and may affect the efficacy of enteral medications, all of which may be result in poor patient outcomes. Gastric motility is affected by critical illness and its associated therapies. Currently available diagnostic tools to identify gastric emptying at the bedside have not been systematically studied and applied in this cohort. Gastric residual volume measurement, used as an indirect marker of delayed gastric emptying in PICUs around the world, may be inaccurate.
Conclusions:
Gastric dysmotility is common in critically ill children and impacts patient safety and outcomes. However, it is poorly understood, inadequately defined, and current therapies are limited and based on scant evidence. Understanding gastric motility and developing accurate bedside measures and novel therapies for gastric emptying are highly desirable and need to be further investigated.
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