Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems

• Published in: Intensive care medicine 2012-03, Vol.38 (3), p.384-394
• Main Authors: Reintam Blaser, Annika, Malbrain, Manu L. N. G., Starkopf, Joel, Fruhwald, Sonja, Jakob, Stephan M., De Waele, Jan, Braun, Jan-Peter, Poeze, Martijn, Spies, Claudia
• Format: Article
• Language: English
• Subjects: Abdomen; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Associations, institutions, etc; Biological and medical sciences; Clinical death. Palliative care. Organ gift and preservation; Conference Reports and Expert Panel; Critical Care - methods; Critical Care - standards; Critical Care Medicine; Critical Illness - therapy; Emergency Medicine; Evidence, Expert; feeding; Gastrointestinal Diseases - classification; Gastrointestinal Diseases - physiopathology; Gastrointestinal Diseases - therapy; Gastrointestinal system; gastrointestinal tract; Gastrointestinal Tract - physiology; Gastrointestinal Tract - physiopathology; Health aspects; Hospitals; Humans; Illnesses; Intensive; Intensive care; Intensive care medicine; intervention; Medical sciences; Medicine; Medicine & Public Health; Multiple organ dysfunction syndrome; Pain Medicine; Pathophysiology; Pediatrics; Pneumology/Respiratory System; Reviews; Severity of Illness Index; Societies; Terminology; Terminology as Topic; Working groups
• ISSN: 0342-4642; 1432-1238; 1432-1238
• DOI: 10.1007/s00134-011-2459-y

Purpose Acute gastrointestinal (GI) dysfunction and failure have been increasingly recognized in critically ill patients. The variety of definitions proposed in the past has led to confusion and difficulty in comparing one study to another. An international working group convened to standardize the definitions for acute GI failure and GI symptoms and to review the therapeutic options. Methods The Working Group on Abdominal Problems (WGAP) of the European Society of Intensive Care Medicine (ESICM) developed the definitions for GI dysfunction in intensive care patients on the basis of the available evidence and current understanding of the pathophysiology. Results Definitions for acute gastrointestinal injury (AGI) with its four grades of severity, as well as for feeding intolerance syndrome and GI symptoms (e.g. vomiting, diarrhoea, paralysis, high gastric residual volumes) are proposed. AGI is a malfunctioning of the GI tract in intensive care patients due to their acute illness. AGI grade I = increased risk of developing GI dysfunction or failure (a self-limiting condition); AGI grade II = GI dysfunction (a condition that requires interventions); AGI grade III = GI failure (GI function cannot be restored with interventions); AGI grade IV = dramatically manifesting GI failure (a condition that is immediately life-threatening). Current evidence and expert opinions regarding treatment of acute GI dysfunction are provided. Conclusions State-of-the-art definitions for GI dysfunction with gradation as well as management recommendations are proposed on the basis of current medical evidence and expert opinion. The WGAP recommends using these definitions for clinical and research purposes.