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Beyond Description: A Functional GIUS-Based Algorithm for Enteral Feeding Decisions in the ICU
Nick Weidner1, Christian von Löffelholz2, Robert Patejdl3
1Department of Intensive Care, Helios Clinic Erfurt, 99089 Erfurt, Germany.
Journal of Personalized Medicine
|July 27, 2026
Summary
Gastrointestinal ultrasound (GIUS) offers a noninvasive bedside tool to assess critically ill patients
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Diagnostic Imaging
Background:
- Gastrointestinal dysfunction is prevalent in critically ill patients, complicating enteral nutrition delivery and tolerance.
- Traditional bedside markers for gastrointestinal assessment lack diagnostic accuracy and fail to capture dynamic functional changes.
Purpose of the Study:
- To review the physiology and pathophysiology of gastric emptying and intestinal transit in critically ill patients.
- To summarize established gastrointestinal ultrasound (GIUS) protocols and propose GIUS-based algorithms for enteral feeding decisions.
- To evaluate the clinical relevance of GIUS parameters in managing nutritional support.
Main Methods:
- Narrative review of existing literature on GIUS in critically ill patients.
- Summary of established GIUS protocols: GUTS, AGIUS, Lai protocol, and UMAT.
- Proposal of pragmatic GIUS-based algorithms for enteral feeding decisions in three clinical scenarios.
Main Results:
- Key sonographic parameters like gastric antral cross-sectional area and small-bowel diameter show clinical relevance.
- Other measures (mucosal thickness, colonic wall thickness, Doppler indices) require further validation.
- Ultrasound Meal Accommodation Test (UMAT) offers dynamic assessment of gastric accommodation and emptying.
Conclusions:
- Structured GIUS protocols represent a promising extension of bedside assessment for enteral nutrition management in ICUs.
- Further prospective multicenter studies are needed to validate GIUS algorithms as stand-alone decision tools.
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