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Gastrointestinal Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference
Katri V Typpo1, Sharon Y Irving2, Jose M Prince3
1Department of Pediatrics and the Steele Children's Research Center, University of Arizona College of Medicine, Tucson, Arizona.
Insights
New criteria for severe gastrointestinal dysfunction in critically ill children were developed. These criteria include specific findings like bowel perforation or ischemia, aiding in the understanding of pediatric multiple organ dysfunction syndrome (MODS).
Area of Science:
- Pediatric critical care medicine
- Gastroenterology
- Diagnostic criteria development
Background:
- Existing criteria for pediatric multiple organ dysfunction syndrome (MODS) lack specific inclusion of gastrointestinal dysfunction.
- Gastrointestinal dysfunction plays a significant role in the pathophysiology and outcomes of pediatric critical illness.
Purpose of the Study:
- To evaluate existing evidence on gastrointestinal dysfunction in critically ill children.
- To develop consensus criteria for identifying severe gastrointestinal dysfunction in this population.
Main Methods:
- A systematic electronic literature search of PubMed and EMBASE (1992-2020) was performed.
- Inclusion criteria focused on critically ill children with gastrointestinal dysfunction and relevant outcome assessments.
- Exclusion criteria removed studies on adults, premature infants, animal models, and non-English literature.
Main Results:
- Severe gastrointestinal dysfunction criteria include: 1a) bowel perforation, 1b) pneumatosis intestinalis, or 1c) bowel ischemia, confirmed by imaging or surgical inspection.
- Alternatively, rectal sloughing of gut mucosa is also indicative of severe gastrointestinal dysfunction.
- These criteria were derived from a systematic review of eligible studies.
Conclusions:
- The developed consensus criteria provide a framework for defining severe gastrointestinal dysfunction in critically ill children.
- Further research is needed to enhance the validity of these criteria due to current evidence limitations.
- Accurate identification of gastrointestinal dysfunction is crucial for understanding and managing pediatric MODS.
Context:
Prior criteria to define pediatric multiple organ dysfunction syndrome (MODS) did not include gastrointestinal dysfunction.
Objectives:
Our objective was to evaluate current evidence and to develop consensus criteria for gastrointestinal dysfunction in critically ill children.
Data Sources:
Electronic searches of PubMed and EMBASE were conducted from January 1992 to January 2020, using medical subject heading terms and text words to define gastrointestinal dysfunction, pediatric critical illness, and outcomes.
Study Selection:
Studies were included if they evaluated critically ill children with gastrointestinal dysfunction, performance characteristics of assessment/scoring tools to screen for gastrointestinal dysfunction, and assessed outcomes related to mortality, functional status, organ-specific outcomes, or other patient-centered outcomes. Studies of adults or premature infants, animal studies, reviews/commentaries, case series with sample size ≤10, and non-English language studies with inability to determine eligibility criteria were excluded.
Data Extraction:
Data were abstracted from each eligible study into a standard data extraction form along with risk of bias assessment by a task force member.
Results:
The systematic review supports the following criteria for severe gastrointestinal dysfunction: 1a) bowel perforation, 1b) pneumatosis intestinalis, or 1c) bowel ischemia, present on plain abdominal radiograph, computed tomography (CT) scan, magnetic resonance imaging (MRI), or gross surgical inspection, or 2) rectal sloughing of gut mucosa.
Limitations:
The validity of the consensus criteria for gastrointestinal dysfunction are limited by the quantity and quality of current evidence.
Conclusions:
Understanding the role of gastrointestinal dysfunction in the pathophysiology and outcomes of MODS is important in pediatric critical illness.
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