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Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems

Reintam Blaser, Annika ; Malbrain, Manu ; Starkopf, Joel ; Fruhwald, Sonja ; Jakob, Stephan ; De Waele, Jan ; Braun, Jan-Peter ; Poeze, Martijn ; Spies, Claudia

In: Intensive Care Medicine, 2012, vol. 38, no. 3, p. 384-394

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    Title
    • Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems
    Author
    • Reintam Blaser, Annika. Clinic of Anaesthesiology and Intensive Care, University of Tartu, Puusepa 8, 51014, Tartu, Estonia
    • Malbrain, Manu. Intensive Care Unit, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerpen, Belgium
    • Starkopf, Joel. Clinic of Anaesthesiology and Intensive Care, University of Tartu, Puusepa 8, 51014, Tartu, Estonia
    • Fruhwald, Sonja. Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
    • Jakob, Stephan. Department of Intensive Care Medicine, University Hospital (Inselspital) and University of Bern, 3010, Bern, Switzerland
    • De Waele, Jan. Department of Critical Care Medicine, Ghent University Hospital and Ghent Medical School, De Pintelaan 185, 9000, Ghent, Belgium
    • Braun, Jan-Peter. Department of Anaesthesiology and Intensive Care, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
    • Poeze, Martijn. Division of Traumatology, Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands
    • Spies, Claudia. Department of Anaesthesiology and Intensive Care, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:312471
    Summary
    Purpose: Acute gastrointestinal (GI) dysfunction and failure have been increasingly recognized in critically ill patients. The variety of definitions proposed in the past has led to confusion and difficulty in comparing one study to another. An international working group convened to standardize the definitions for acute GI failure and GI symptoms and to review the therapeutic options. Methods: The Working Group on Abdominal Problems (WGAP) of the European Society of Intensive Care Medicine (ESICM) developed the definitions for GI dysfunction in intensive care patients on the basis of the available evidence and current understanding of the pathophysiology. Results: Definitions for acute gastrointestinal injury (AGI) with its four grades of severity, as well as for feeding intolerance syndrome and GI symptoms (e.g. vomiting, diarrhoea, paralysis, high gastric residual volumes) are proposed. AGI is a malfunctioning of the GI tract in intensive care patients due to their acute illness. AGI grade I=increased risk of developing GI dysfunction or failure (a self-limiting condition); AGI grade II=GI dysfunction (a condition that requires interventions); AGI grade III=GI failure (GI function cannot be restored with interventions); AGI grade IV=dramatically manifesting GI failure (a condition that is immediately life-threatening). Current evidence and expert opinions regarding treatment of acute GI dysfunction are provided. Conclusions: State-of-the-art definitions for GI dysfunction with gradation as well as management recommendations are proposed on the basis of current medical evidence and expert opinion. The WGAP recommends using these definitions for clinical and research purposes