Abstract
Objectives:To determine the frequency and predictors of outcome of gastrointestinal complications (GIC) in critically ill children.Methods:This descriptive study was prospectively conducted in The Pediatric Intensive Care Unit (PICU), The Aga Khan University Hospital (AKUH), Karachi, from September 2015 to January 2017. After obtaining approval from the Ethical Review Committee of AKUH and informed consent from the parents, all children (aged one month to 18 years), of either gender, admitted to the Pediatric Intensive Care Unit (PICU) during the study period were included. The frequency of the defined GIC: vomiting, high gastric residue volume (GRV), diarrhea, constipation, and gastrointestinal bleed were recorded daily for the first week of the PICU stay. The data was collected by the primary investigator on a predesigned data collection form with inclusion of variables and predictors in light of existing literature and local expertise. The questionnaire was shared with the Pediatric Critical Care Medicine faculty and a consensus was sought on the elements to be incorporated.Results:GIC developed within the first 48 hours of admission in 78 (41%) patients. Of the patients who developed GIC, 37 (47.4%) patients developed high GRV: 31 (39.7%) patients developed constipation, 18 (23.1%) patients developed vomiting, 14 (17.9%) patients developed abdominal distension. With regards to prevalence by occurrence, 32/78 (41%) of patients presented with two GI complications, followed by 21 patients (27%) who presented with a single GIC. Only 11 patients (14%) presented with more than three complications. Median length of stay was higher in patients with GIC (8 days) than with those who did not develop GIC (4 days). The frequency of gastrointestinal complications was significantly higher in children receiving mechanical ventilation, on sedatives and relaxants and those with multiorgan dysfunction syndrome (MODS) and inotropesConclusion:GI complications are a frequent occurrence in the PICU and are associated with worse clinical outcomes. The use of sedative drugs and the presence of shock with MODS were amongst the important contributing factors.
Highlights
Gastrointestinal complications (GIC) are common in critically ill children.[1]
Based on a study by Lopez-Herce et al, that reported a frequency of GIC in critically ill children to be 11.5%3 with a margin of error of 5%, a power (1-β) of 80%, 190 patients were included in this study by using nonprobability, consecutive sampling technique
From a total of 448 patients screened for eligibility, 190 patients met inclusion criteria and 78 (41%) developed one or more GIC during the first week of their Pediatric Intensive Care Unit (PICU) admission
Summary
Gastrointestinal complications (GIC) are common in critically ill children.[1] GIC are commonly observed, as either a primary reason for admission or as a part of multiple organ dysfunction syndrome (MODS) in children admitted in the Pediatric Intensive Care Unit (PICU). The lack of a uniform standard definition of GIC adds to delays in its recognition.[3,4] Critical illness can result in intestinal mucosal ischemia, that further damages the gut barrier function.[5] Recently with the increasing awareness of GIC in critically ill patients, the Working Group on Abdominal Problems (WGAP) of the European Society of Intensive Care Medicine (ESICM) proposed a set of definitions of acute gastrointestinal injury (AGI) in critical illnesses in adults for both clinical and research purposes.[2] there is no such definition available for the pediatric population. The associations between AGI grade, the severity of GI dysfunction, and adverse outcome remains to be elucidated
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