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Yu T, Cai F, Jiang R. Effects of Early Bedside Cycle Exercise on Gastrointestinal Function in Intensive Care Unit Patients Receiving Mechanical Ventilation. Front Med (Lausanne) 2022; 9:823067. [PMID: 35755035 PMCID: PMC9218181 DOI: 10.3389/fmed.2022.823067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background A prolonged stay in the intensive care unit (ICU) is associated with gastrointestinal failure, which may have a destructive effect on functional status within 1 year after hospital discharge. The aim was to investigate the effects of a daily exercise session, using a bedside cycle ergometer, on gastrointestinal functions, such as diarrhea, gastric retention, and vomiting, in patients with severe pneumonia who received mechanical ventilation (MV). Methods The study was a randomized controlled trial, and its setting was the ICU of a tertiary hospital in Eastern China. A total of 102 critically ill patients who received MV were recruited only when their cardiorespiratory function was deemed stable to perform a bedside cycling exercise. Those patients were expected to spend a minimum of 7 days in the ICU. All subjects received respiratory physiotherapy and performed a daily standardized passive or active motion session of their limbs. The patients were randomized into two groups, namely, the treatment group, which were administered passive or active leg exercise intervention for 20 min/day using a bedside ergometer, and the control group, which did not. Gastrointestinal (GI) functions and the nutritional status of both groups were evaluated on the first, fourth, and seventh days of training and at discharge. Results During the 7 days of the study, the number of patients with diarrhea in the treatment group was significantly lower than that in the control group. In contrast, there were significantly more patients in the treatment group with increased bowel sounds (P < 0.05). However, there was no significant difference in the number of patients with vomiting and gastric retention between these two groups. Moreover, when the patients were discharged from the hospital, the albumin level and lymphocyte count were significantly higher in the treatment group (P < 0.05). In addition, the number of invasive ventilation days in the treatment group was less than that in the control group (P < 0.05). While the ICU length of stay and the total hospitalization time were not significantly different between the two groups. Conclusion Early exercise training in critical ICU survivors who received MV enhanced the recovery of gastrointestinal functions and improved the patient’s nutrition status at hospital discharge.
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Affiliation(s)
- Tingting Yu
- Intensive Care Unit, The First People's Hospital of Kunshan, Kunshan, China
| | - Fuliang Cai
- Intensive Care Unit, The First People's Hospital of Kunshan, Kunshan, China
| | - Rong Jiang
- Department of Clinical Nursing, School of Nursing, Nanjing Medical University, Nanjing, China
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Teng J, Xiang L, Long H, Gao C, Lei L, Zhang Y. The Serum Citrulline and D-Lactate are Associated with Gastrointestinal Dysfunction and Failure in Critically Ill Patients. Int J Gen Med 2021; 14:4125-4134. [PMID: 34377012 PMCID: PMC8349205 DOI: 10.2147/ijgm.s305209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/18/2021] [Indexed: 12/12/2022] Open
Abstract
Objective This study attempted to screen and combine effective biomarkers to analyse the association between these biomarkers and gastrointestinal failure (GIF) in critically ill patients. Methods A total of 110 critically ill patients with acute gastrointestinal injury (AGI) admitted to ICU were enrolled. The AGI grade was determined by the AGI classification proposed by ESICM. There were 67 patients in gastrointestinal dysfunction (GID) group (AGI grade II), 43 patients in GIF group (AGI grade III–IV), and 41 healthy adults in healthy control (HC) group. APACHE II and SOFA score were used to evaluate the disease severity. Peripheral blood samples of patients were collected within 24 hours of admission to the ICU (prior-treatment) and after the conventional medication therapy for 7 consecutive days (post-treatment). Citrulline serum level was detected by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method, and D-lactate and lipopolysaccharide (LPS) serum levels were measured by ELISA. Pearson correlation, logistic regression, and ROC curve analysis were used. Results Patients with GID or GIF had lower serum level of citrulline, while higher levels of D-lactate and LPS than HC. Compared with GID patients, serum level of citrulline was reduced, while D-lactate and LPS were elevated in GIF patients. Correlation analysis displayed that serum levels of citrulline, D-lactate, and LPS were associated with the APACHE II and SOFA score in patients with GID or GIF. Logistics regression analysis showed that citrulline and D-lactate were risk for both GID and GIF. ROC curve analysis exhibited that combination of citrulline and D-lactate had relatively high value to distinguish GID from HC, GIF from GID, and GIF from HC. Conclusion Serum citrulline and D-lactate were associated with severity of GIF, combination of citrulline and D-lactate improved the diagnostic efficacy to identify GIF in critically ill patients.
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Affiliation(s)
- Jin Teng
- Department of Cadre Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu City, Sichuan Province, 610072, People's Republic of China
| | - Lu Xiang
- Department of Geriatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu City, Sichuan Province, 610072, People's Republic of China
| | - Huaicong Long
- Department of Geriatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu City, Sichuan Province, 610072, People's Republic of China
| | - Caiping Gao
- Department of Digestive Internal Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu City, Sichuan Province, 610072, People's Republic of China
| | - Lei Lei
- Department of Digestive Internal Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu City, Sichuan Province, 610072, People's Republic of China
| | - Yinghui Zhang
- Department of Digestive Internal Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu City, Sichuan Province, 610072, People's Republic of China
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Jin W, Guo X, Li Q, Luo X, Zhong J, Song Y, Hou W, Guo Y, Li Y, Luo J. Potential preventive and therapeutic effect of Chinese herb rhubarb (da huang) for intensive care unit/pediatric intensive care unit gastrointestinal failure patients: A protocol for systematic review. Medicine (Baltimore) 2020; 99:e20188. [PMID: 32443339 PMCID: PMC7254143 DOI: 10.1097/md.0000000000020188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The Chinese herb da huang (DH) (Rhubarb) is commonly used for GIF intensive care unit (ICU)/pediatric intensive care unit (PICU) gastrointestinal failure (GIF) patients in China. However, the potential preventive and therapeutic effect of DH in these patients has not yet been studied systematically. OBJECTIVES The aim of this study was to evaluate the preventive and therapeutic effects of DH in treating ICU/PICU GIF patients with the most recent evidence. METHODS We systematically searched 7 databases from inception to March 30, 2018. RevMan 5.3 software was used to perform a meta-analysis. GRADE methodology was applied to evaluate the quality of evidence for each outcome. The review protocol was registered on PROSPERO (CRD42018092710) in advance. RESULTS Seven studies comprising 788 pediatric or adult participants were included in this analysis. Three indicators, including GIF occurrence rates (gastrointestinal mucosal hemorrhage, enteroplegia), multiple organ dysfunction syndrome (MODS)-related items (occurrence rates of MODS, mortality rates of MODS) and duration in the ICU was analyzed. The GIF occurrence rate meta-analysis result was (RR 0.47, CI 95% 0.37-0.60; P = .95); MODS related items indicator result was (RR 0.44, CI 95% 0.33-0.59; P = .41); ICU duration ICU result was (RR -2.87, CI 95% -3.53--2.21; P = .40). The safety of Chinese herb DH (Rhubarb) remains unclear. CONCLUSION Current evidence suggests that the Chinese herb rhubarb (DH) powder combined with Western medicine was inferior to Western medicine alone in terms of preventive and therapeutic effects in ICU/PICU patients in terms of decreasing GIF occurrence rates (gastrointestinal mucosal hemorrhage and enteroplegia), occurrence rates of MODS, mortality from MODS, and shortened duration time in the ICU/PICU. However, larger sample sizes and rigorously-designed studies are necessary to conclusively determine the association between DH powder and outcomes in ICU/PICU GIF patients.
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Affiliation(s)
- Wei Jin
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan
| | - Xiaohui Guo
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan
| | - Qingjie Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan
| | - Xiaoqiong Luo
- Chongqing Traditional Chinese Medicine Hospital, Chongqing
| | - Juan Zhong
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan
| | - Yang Song
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan
| | - Weiwei Hou
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan
| | - Yucui Guo
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan
| | - Yiwei Li
- The Second Hospital of Sichuan of TCM, Chengdu, Sichuan, China
| | - Junping Luo
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan
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Jin M, Zhang HM, Chen XF, Wu MX, Wang Z, Guo MY, Bai XY, Yang H, Qian JM. [Evaluation and Early Diagnosis of Gastrointestinal Failure in Acute Pancreatitis]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2020; 42:47-54. [PMID: 32131939 DOI: 10.3881/j.issn.1000-503x.11240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective To investigate the application of Acute Gastrointestinal Injury(AGI) grading in evaluating gastrointestinal failure in patients with acute pancreatitis(AP). Methods In this retrospective observational study,patients presented with moderate severe AP and severe AP in our hospital from October 2013 to October 2016 were consecutively enrolled.Logistic regression analysis and receiver operating characteristic curve were used to explore and evaluate potential predictors of gastrointestinal failure. Results A total of 202 patients were included in this study,with 90 cases(44.6%) identified as gastrointestinal failure.Survival curve showed significantly increased risk of death in patients with gastrointestinal failure(P < 0.05).Logistic regression analysis showed age(OR=1.06,95%CI:1.03-1.09,P<0.001),complaint of stopping flatus and defecation(OR=7.02,95%CI:2.08-23.66,P=0.002),increased counts of white blood cells in peripheral blood(OR=1.09,95%CI:1.02-1.17,P=0.015),decreased level of serum albumin(OR=0.93,95%CI:0.86-1.00,P=0.048),and increased level of serum creatinine at admission(OR=1.02,95%CI:1.01-1.04,P=0.001) were the independent risk factors of gastrointestinal failure.The area under curves of Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) and Beside Index for Severity in Acute Pancreatitis (BISAP) scores in diagnosing gastrointestinal failure were 0.999 and 0.782,respectively. Conclusions Gastrointestinal failure can remarkably increase the risk of death in patients with AP.Both APACHE Ⅱ and BISAP scores at admission are useful in diagnosing gastrointestinal failure in patients with AP.
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Affiliation(s)
- Meng Jin
- Department of Gastroenterology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Hui Min Zhang
- Department of Gastroenterology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Xuan Fu Chen
- Department of Gastroenterology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Mei Xu Wu
- Department of Gastroenterology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Zheng Wang
- Department of Gastroenterology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Ming Yue Guo
- Department of Gastroenterology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Xiao Yin Bai
- Department of Gastroenterology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Hong Yang
- Department of Gastroenterology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Jia Ming Qian
- Department of Gastroenterology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
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Asrani VM, Brown A, Bissett I, Windsor JA. Impact of Intravenous Fluids and Enteral Nutrition on the Severity of Gastrointestinal Dysfunction: A Systematic Review and Meta-analysis. ACTA ACUST UNITED AC 2020; 6:5-24. [PMID: 32104727 DOI: 10.2478/jccm-2020-0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 01/30/2020] [Indexed: 12/11/2022]
Abstract
Introduction Gastrointestinal dysfunction (GDF) is one of the primary causes of morbidity and mortality in critically ill patients. Intensive care interventions, such as intravenous fluids and enteral feeding, can exacerbate GDF. There exists a paucity of high-quality literature on the interaction between these two modalities (intravenous fluids and enteral feeding) as a combined therapy on its impact on GDF. Aim To review the impact of intravenous fluids and enteral nutrition individually on determinants of gut function and implications in clinical practice. Methods Randomized controlled trials on intravenous fluids and enteral feeding on GDF were identified by a comprehensive database search of MEDLINE and EMBASE. Extraction of data was conducted for study characteristics, provision of fluids or feeding in both groups and quality of studies was assessed using the Cochrane criteria. A random-effects model was applied to estimate the impact of these interventions across the spectrum of GDF severity. Results Restricted/ goal-directed intravenous fluid therapy is likely to reduce ‘mild’ GDF such as vomiting (p = 0.03) compared to a standard/ liberal intravenous fluid regime. Enterally fed patients experienced increased episodes of vomiting (p = <0.01) but were less likely to develop an anastomotic leak (p = 0.03) and peritonitis (p = 0.03) compared to parenterally fed patients. Vomiting (p = <0.01) and anastomotic leak (p = 0.04) were significantly lower in the early enteral feeding group. Conclusions There is less emphasis on the combined approach of intravenous fluid resuscitation and enteral feeding in critically ill patients. Conservative fluid resuscitation and aggressive enteral feeding are presumably key factors contributing to severe life-threatening GDF. Future trials should evaluate the impact of cross-interaction between conservative and aggressive modes of these two interventions on the severity of GDF.
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Reintam Blaser A, Starkopf J, Moonen PJ, Malbrain MLNG, Oudemans-van Straaten HM. Perioperative gastrointestinal problems in the ICU. Anaesthesiol Intensive Ther 2017; 50:59-71. [PMID: 29152709 DOI: 10.5603/ait.a2017.0064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/15/2017] [Indexed: 11/25/2022] Open
Abstract
Gastrointestinal (GI) problems after surgery are common and are not limited to patients undergoing abdominal surgery. GI function is complicated to monitor and is not included in organ dysfunction scores widely used in the ICUs. In most cases, it recovers after surgery, if systemic and local inflammation and perfusion improve, gut oedema resolves, and analgosedation is reduced. However, perioperative GI problems may have severe consequences and increase the risk of death if not recognized and managed in a timely manner. Careful risk evaluation followed by a complex structured assessment and appropriate management of GI symptoms should minimize the potentially severe consequences and thereby possibly improve outcome. In the current review, we summarize common non-specific perioperative GI problems and some specific surgery-related abdominal problems, address identification of patients at risk of GI problems, and give suggestions for perioperative GI management.
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Affiliation(s)
- Annika Reintam Blaser
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland; Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.
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Reintam Blaser A, Malbrain MLNG, Regli A. Abdominal pressure and gastrointestinal function: an inseparable couple? Anaesthesiol Intensive Ther 2017; 49:146-158. [PMID: 28513822 DOI: 10.5603/ait.a2017.0026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/01/2017] [Indexed: 11/25/2022] Open
Abstract
Evaluating the degree of organ dysfunction is a cornerstone in distinguishing patients with critical illness from those without. However, evaluation of the gastrointestinal function in critically ill patients is not unified, and is still largely based on subjective clinical evaluation. Although intra-abdominal pressure has been proposed as a parameter to facilitate monitoring of abdominal compartment in critical illness, the interactions between intra-abdominal pressure and gastrointestinal function are poorly clarified. The aim of this current review is to describe interactions and associations between gastrointestinal dysfunction and intra-abdominal pressure from a pathophysiological and clinical point of view.
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Affiliation(s)
- Annika Reintam Blaser
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland; Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.
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