Glucagon-like peptide-1 drugs, gastrointestinal function and critical illness

As the use of long-acting glucagon-like peptide-1 (GLP-1) drugs in the community grows rapidly, an increasing number of patients in the ICU will be affected by the preexisting GLP-1 therapy. This review highlights recent major advances in the use of GLP-1 drugs and their impact on gastrointestinal function, aiming to assist intensive care clinicians in developing informed management strategies.

Although the gastrointestinal inhibitory effects of GLP-1 therapy are well established, this is not clearly associated with inpatient complications. The risk of pulmonary aspiration peri-operatively is low and GLP-1 therapy does not clearly increase this risk peri-operatively. Similarly, there is no clear association with either small intestinal obstruction or acute pancreatitis. The potential impact on enteral nutrition provision is unlikely to be detrimental in the acute phase of critical illness.

A systematic approach is necessary to assess gastrointestinal function and monitor for complications. Gastric ultrasound and prokinetic therapy may be useful peri-operatively to detect retained gastric contents and mitigate the risk of pulmonary aspiration. Future research may elaborate the role of GLP-1 therapy in the acute setting for stress hyperglycaemia in the critically ill.