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Gastrointestinal failure in the ICU.

Annika Reintam Blaser1, Stephan M Jakob, Joel Starkopf

  • 1aDepartment of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland bDepartment of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia cDepartment of Intensive Care Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland dDepartment of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia.

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Defining gastrointestinal failure in ICU patients is challenging. Current management relies on assessing symptoms and feeding intolerance due to a lack of reliable biomarkers for gastrointestinal dysfunction.

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Area of Science:

  • Critical Care Medicine
  • Gastroenterology
  • Physiology

Background:

  • Gastrointestinal dysfunction is common in critically ill patients.
  • Previous definitions of gastrointestinal failure lack standardization.
  • Acute gastrointestinal injury (AGI) is a proposed term for gastrointestinal dysfunction within multiple organ dysfunction syndrome.

Purpose of the Study:

  • To review methods for assessing gastrointestinal function in adult ICU patients.
  • To outline a practical approach for managing gastrointestinal dysfunction in the ICU.

Main Methods:

  • Review of current literature on gastrointestinal function assessment.
  • Discussion of pathophysiological mechanisms of gastrointestinal dysfunction.
  • Analysis of subjective and objective measures for monitoring gastrointestinal status.

Main Results:

  • No single marker reliably quantifies gastrointestinal dysfunction.
  • Assessment relies on a combination of symptoms and feeding intolerance, introducing subjectivity.
  • The utility of biomarkers like citrulline and parameters such as intra-abdominal pressure requires further investigation.

Conclusions:

  • Establishing a clear definition for gastrointestinal failure is crucial for advancing research.
  • A systematic approach to managing gastrointestinal issues in ICU patients is recommended.
  • Further research is needed to validate novel biomarkers and parameters for gastrointestinal assessment.