Association between acute gastrointestinal injury and biomarkers of intestinal barrier function in critically ill patients

Abstract Background This study examined the feasibility of transabdominal intestinal ultrasonography in evaluating acute gastrointestinal injury (AGI). Methods A total of 116 patients were included. Intestinal ultrasonography was conducted daily within 1 week after admission to the intensive care unit. Ultrasonography indicators including intestinal diameter, changes in the intestinal folds, thickness of the intestinal wall, stratification of the intestinal wall, and intestinal peristalsis (movement of the intestinal contents) were observed to determine the acute gastrointestinal injury ultrasonography (AGIUS) score. The gastrointestinal and urinary tract sonography ultrasound (GUTS) protocol score was also calculated. During the first week of the study, the gastrointestinal failure (GIF) score was determined daily. The correlations between transabdominal intestinal scores (AGIUS and GUTS) and the GIF score were analyzed to clarify the feasibility of evaluating AGI through observation of the intestine. The utility of intestinal ultrasonography indicators in predicting feeding intolerance was investigated to improve the ability of clinicians to manage AGI. Results A total of 751 ultrasonic examinations were performed with 511 images (68%) considered to be of “good quality.” AGIUS and GUTS scores differed significantly between AGI patients (GIF score 0–2) and non-AGI patients (GIF score 3–4) (p < 0.001). Both scores correlated positively with GIF score (r = 0.54, p < 0.001; r = 0.66, p < 0.001). These ultrasonography indicators could predict feeding intolerance, with an area under the receiver operating characteristic curve of 0.60 (0.48–0.71; intestinal diameter), 0.76 (0.67–0.85; intestinal folds), 0.71 (0.62–0.80; wall thickness), 0.77 (0.69–0.86; wall stratification), and 0.78 (0.68–0.88; intestinal peristalsis). Compared to patients with a normal rate of peristalsis (5–10/min), patients with abnormal peristalsis rates (< 5/min or > 10/min) have increased risk for feeding intolerance (16/83 vs. 25/33, p < 0.001). Conclusions The transabdominal intestinal ultrasonography represents an effective means for assessing gastrointestinal injury in critically ill patients. Intestinal ultrasonography indicators, especially the degree of intestinal peristalsis, may be used to predict feeding intolerance. Trial registration ClinicalTrial.gov, NCT03589248. Registered 04 July 2018—retrospectively registered.

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Association between nutrition support and acute gastrointestinal injury in critically ill patients during the first 72 hours

Clinical Nutrition ◽

10.1016/j.clnu.2020.05.011 ◽

2021 ◽

Vol 40 (1) ◽

pp. 217-221

Author(s):

Hongxiang Li ◽

Junying Lu ◽

Hongyan Li ◽

Aosong Duan ◽

Yushan Wang ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Nutrition Support ◽

Gastrointestinal Injury ◽

Acute Gastrointestinal Injury

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Gut rest strategy and trophic feeding in the acute phase of critical illness with acute gastrointestinal injury

Nutrition Research Reviews ◽

10.1017/s0954422419000027 ◽

2019 ◽

Vol 32 (2) ◽

pp. 176-182 ◽

Cited By ~ 5

Author(s):

Dong Zhang ◽

Hongxiang Li ◽

Yuting Li ◽

Lai Qu

Keyword(s):

Critical Illness ◽

Critically Ill ◽

Acute Phase ◽

Critically Ill Patients ◽

Gastrointestinal Dysfunction ◽

Gastrointestinal Injury ◽

Protective Strategy ◽

Current Guidelines ◽

Acute Gastrointestinal Injury ◽

Trophic Feeding

AbstractCritically ill patients frequently suffer from gastrointestinal dysfunction as the intestine is a vulnerable organ. In critically ill patients who require nutritional support, the current guidelines recommend the use of enteral nutrition within 24–48 h and advancing towards optimal nutritional goals over the next 48–72 h; however, this may be contraindicated in patients with acute gastrointestinal injury because overuse of the gut in the acute phase of critical illness may have an adverse effect on the prognosis. We propose that trophic feeding after 72 h, as a partial gut rest strategy, should be provided to critically ill patients during the acute phase of illness as an organ-protective strategy, especially for those with acute gastrointestinal injury.

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Effect of Dexmedetomidine on Intestinal Barrier in Patients Undergoing Gastrointestinal Surgery - A Single-Centre Randomized Clinical Trial

10.21203/rs.3.rs-150967/v1 ◽

2021 ◽

Author(s):

Yupeng Qi ◽

Wenjing Ma ◽

Yingya Cao ◽

Qun Chen ◽

Qiancheng Xu ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Gastrointestinal Surgery ◽

Intestinal Barrier ◽

Intestinal Barrier Function ◽

Apache Ii Score ◽

Tnf Α ◽

Significant Difference ◽

Gastrointestinal Failure ◽

The Mean

Abstract Background: Gastrointestinal failure accounts for death in critically ill patients. This study aimed to explore the effect and mechanism of dexmedetomidine (DEX) in intestinal barrier function in critically ill patients undergoing gastrointestinal surgery.Methods: Patients undergoing gastrointestinal surgery were randomized into a DEX group (n=21) or an MID group (n=21). Sufentanil was used in both groups for analgesia. In the DEX group, DEX was loaded (1 µg/kg) before sedation and was infused (0.7 µg/kg/h) during sedation. The mean arterial pressure (MAP), heart rate (HR), borborygmus resumption time (BRT), first defecation time (FDT), stay of ICU and hospital were observed. The DAO, D-LAC, TNF-α, IL-6 and α7nAChR levels in plasma or haemocytes were detected before the start of the sedation (0 h) and after the sedation (24 h).Results: There were no significant differences in age, sex, BMI, APACHE II score, SOFA (P>0.05). The MAP between 0 and 24 h presented no significant difference between the groups (P > 0.05), but HR was significantly slower in the DEX group (P=0.042). The recovery time of bowel sounds was significantly earlier in the DEX group (P=0.034). Both of the stay of ICU (P=0.016) and hospital (P=0.031) were significantly shorter in the DEX group. The expression of α7nAChR in the DEX group was significantly higher at 24 h than at 0 h (P=0.002). The D-LAC decreased significantly in the DEX group than MID group at 24 h (P=0.016).Conclusions: DEX maintained the integrity of the intestinal barrier in patients undergoing gastrointestinal surgery through the cholinergic anti-inflammatory pathway.Trial registration:ChiCTR1900024367. Registered 7 July 2019-Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=40832

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