Critical Illness and the Gastrointestinal System.

Abstract

Critical illness can sometimes develop within the gastrointestinal (GI) system. This symposium series describes GI illnesses and phenomena seen within the organs of the GI system in hospitalized adults, particularly those who require critical care. The articles present state-of-the-science information for critical care and advanced practice nurses in the area of GI illnesses and their management, including providing nutrition to the critically ill. These topics are covered with a focus on pathophysiology, advanced assessment and evidence-based interventions, and cutting-edge therapies to allow nurses to innovate and strategize the care of patients with these difficult conditions.Patients of all ages can develop liver disease as a result of various illnesses; this liver disease can take the form of acute liver disease, end-stage liver disease (ESLD), or hepatocellular carcinoma. All of these disorders have significant and life-threatening aspects that require advanced knowledge of the disease processes and the application of interventions to thwart progression of the disease. Pryzbyl et al provide a timely update on the newest therapies to treat and, in some cases cure, the chronic form of liver disease and also analyze cutting-edge strategies to manage acute and acute-on-chronic hepatic failure. They review medical management, including when medical management fails and patients with life-threatening ESLD or acute liver failure undergo liver transplantation. Finally, they describe the most up-to-date preoperative and postoperative management strategies and therapies for transplant patients and examine the evidence on trends in liver transplantation, including methods to expand the donor pool as well as guidance and updates on recipient (candidate) selection.1Bloom and Seckel provide an update on the often-controversial topic of feeding tube insertion and care. They present detailed evidence about methods of insertion and recommendations on how to ensure that tubes are correctly placed and safely maintained. This is important information for acute and critical care nurses, as studies have shown a lack of standardization of clinical practice in feeding tube placement verification,2 checking gastric residuals, holding feedings, and other practices related to enteral nutrition management. Bloom and Seckel discuss best practices for enteral nasogastric feeding tube placement and care, with a focus on preventing the complications associated with this intervention.Finally, in the third article of the series, I describe the physiologic response to the infectious and inflammatory conditions of severe acute pancreatitis and fulminant colitis caused by Clostridium difficile. Patients hospitalized in acute care settings carry risk factors for developing either of these conditions, presenting critical care and advanced practice nurses with significant challenges to their identification and treatment. Severe sequelae of these diseases, including sepsis and systemic inflammatory response syndrome, correlate with the onset of organ failure and poor outcomes.3 The few interventions available to treat severe acute pancreatitis and fulminant colitis caused by C difficile are, for the most part, supportive in nature, but there are some evidence-based strategies described that may improve outcomes in patients experiencing the most severe form of these diseases and for whom there are few effective solutions. Although some of these strategies are still under investigation, they may prove valuable in improving the care available for these patients.Diseases of the GI tract and of the auxiliary organs of the GI system are highly prevalent, and patients with these diseases are seen in adult acute and critical care units. Despite their prevalence, GI system illnesses are often challenging to recognize. These diseases may be chronic in nature, such as with ESLD or acute-on-chronic liver disease, or may develop rapidly, as with acute liver failure or acute infectious/inflammatory conditions of organs of the GI tract. Critical care and advanced practice nurses are at the forefront in identifying and managing these complex disorders with the most state-of-the science strategies available, many of which are presented in this symposium. In addition, there is a clear need for knowledge and experience in nutrition in critical care and in the safe insertion of feeding tubes and their management. This is another area in which advanced practice nurses can be instrumental in forging needed change and updated standards.