Abstract
Finding a simple reproducible routine test is relevant for the determination of post-pyloric feeding tolerance.Aim. To evaluate in a pilot study the usefulness of acetaminophen absorption test with post-pyloric drug administration in patients with generalized secondary peritonitis.Materials and methods. Acetaminophen absorption test was performed in patients with generalized secondary peritonitis. 0.5 g of drug was administered into the lumen of the small intestine through the nasojejunal tube and after 5, 10, 15, 20, 30, 40, 50 and 90 min its blood level was determined. The first group (n=14) of variables was taken from patients whose test was performed immediately after the surgery. The second group results (n=10) were obtained from the same patients who were tested when they were able to absorb >1 l/day of enteral nutrition without signs of intolerance.Results. When comparing the concentration of acetaminophen in the blood after the drug administration into the bowel of patients with peritonitis immediately after surgery and at the time when the assimilation of bowel feeding had become possible, it was found that the most significant differences were detected within the time interval of 5–20 minutes after the drug administration (P<0.001). This time interval is optimal for harvesting blood samples during the acetaminophen test procedure.Conclusion. Bowel absorption of acetaminophen may be informative for predicting the feasibility of adequate post-pyloric enteral feeding of patients with generalized secondary peritonitis.
Highlights
It is known that 62% of critically ill patients develop gastrointestinal (GI) dysfunction [1], and in primary bowel injury, as in patients with generalized secondary peritonitis, such disturbances are always present [2]
Acetaminophen absorption test was performed in patients with generalized secondary peritonitis. 0.5 g of drug was administered into the lumen of the small intestine through the nasojejunal tube and after 5, 10, 15, 20, 30, 40, 50 and 90 min its blood level was determined
When comparing the concentration of acetaminophen in the blood after the drug administration into the bowel of patients with peritonitis immediately after surgery and at the time when the assimilation of bowel feeding had become possible, it was found that the most significant differences were detected within the time interval of 5–20 minutes after the drug administration (P
Summary
It is known that 62% of critically ill patients develop gastrointestinal (GI) dysfunction [1], and in primary bowel injury, as in patients with generalized secondary peritonitis, such disturbances are always present [2]. Always AGI is accompanied by feeding intolerance (FI), when adequate enteral nutrition cannot be provided for a clinical reason (vomiting, high residual gastric volume, diarrhea, gastrointestinal bleeding, intestinal fistulas, etc.). There are quite a few methods to assess the gastric emptying function in critically ill patients [4]. Even minimal abnormalities in intestinal morphology or function are known to reduce its ability to absorb nutrients and medications (acetaminophen [paracetamol]) [6]. There is no method to assess the absorption of the food introduced into the intestinal lumen. Our study is aimed at finding a simple test reproducible in everyday clinical practice and capable of assessing the tolerability of post-pyloric feeding
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