Gastrointestinal (GI) disorders are a common problem among patients in the intensive care units (ICUs). They include a wide range of pathological conditions resulting from impaired GI motility, imbalance of gut microbiome, disrupted mucosal barrier integrity, compromised mesenteric perfusion, and altered bile homeostasis. During the stay in the ICU, almost 60% of patients develop some form of GI dysfunction. Clinical evaluation is difficult because of the lack of uniform guidelines, standardized diagnostic protocols, and a universal tool for GI function monitoring. A newly proposed scoring system for quantification of GI dysfunction in this patient population, known as the gastrointestinal dysfunction score (GIDS), is still undergoing validation. Therefore, the assessment of GI insufficiency in the ICU is based on data obtained from a detailed clinical examination, laboratory measurements, and some of the radiological imaging techniques. Information on enteral feeding intolerance, gastric residual volume, values of intra-abdominal pressure, possible GI bleeding, and blood lactate concentration are of key importance. Patients with GI dysfunction have a high risk of developing complications that are associated with prolonged ICU stays and higher mortality. The most severe include bowel ischemia, sepsis due to bacterial translocation, perforation of the digestive tube, GI hemorrhage, and abdominal compartment syndrome. At this moment, there is a continuous need for finding new methods and defining clear diagnostic criteria for detection and quantification of this group of disorders. Timely determination of the underlying pathophysiological process with appropriate therapy and individualized nutritional support aimed at preventing malnutrition, dehydration, and micronutrient deficit effectively improves clinical outcomes in critically ill patients.
Helena Ostović (Mon,) studied this question.