Abstract
To determine whether elevated intra-abdominal pressure (IAP) is associated with a higher rate of enteral nutrition-related gastrointestinal (GI) complications; to assess the value of IAP as a predictor of enteral nutrition (EN) intolerance. Intensive Care Unit (ICU) patients on mechanical ventilation requiring at least 5 days of EN were recruited for a prospective, observational, non-interventional, multicenter study. EN was performed and GI complications were managed with an established protocol. IAP was determined via a urinary catheter. Patients who developed any GI complications were considered as presenting EN intolerance. Variables related to EN, IAP and GI complications were monitored daily. Statistical analysis compared patients without GI complications (group A) vs. GI complications (group B). 247 patients were recruited from 28 participating ICUs (group A: 119, group B: 128). No differences between groups were recorded. Patients in group B (p < 0.001) spent more days on EN (8.1 ± 8.4 vs. 18.1 ± 13.7), on mechanical ventilation (8.0 ± 7.7 vs. 19.3 ± 14.9) and in the ICU (12.3 ± 11.4 vs. 24.8 ± 17.5). IAP prior to the GI complication was (14.3 ± 3.1 vs. 15.8 ± 4.8) (p < 0.003). The best IAP value identified for EN intolerance was 14 mmHg but it had low sensitivity and specificity. Although a higher IAP was associated with EN intolerance, IAP alone did not emerge as a good predictor of EN intolerance in critically ill patients.
Highlights
Enteral nutrition (EN) is the preferred route for artificial nutrition in critically ill patients [1]
EN intolerance is considered in critically ill patients who present signs and symptoms such as vomiting, regurgitation, abdominal distension, diarrhea and constipation
We investigate the value of intra-abdominal pressure level (IAP) as a marker for anticipating, or predicting, the development of GI complications in these patients
Summary
Enteral nutrition (EN) is the preferred route for artificial nutrition in critically ill patients [1]. EN appears to protect the structure and function of the digestive tract, limiting bacterial translocation [2], and it is associated with fewer, and less severe, complications than parenteral nutrition [3,4]. Early EN (initiated within 24 h of patient admission) has been associated with reductions in the incidence of infectious complications, hospital stay, and mortality [5]. EN is associated with a high incidence of related gastrointestinal (GI) complications in critically ill patients [6,7]. EN intolerance is considered in critically ill patients who present signs and symptoms such as vomiting, regurgitation, abdominal distension, diarrhea and constipation. Our study group has previously worked on defining and managing GI complications in Intensive Care
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