The impact of admission diagnosis on gastric emptying in critically ill patients

Abstract

Introduction: Disturbed gastric emptying (GE) occurs commonly in critically ill patients. Admission diagnoses are believed to influence the incidence of delayed GE and subsequent feed intolerance. Although patients with burns and head injury are considered to be at greater risk, the true incidence has not been determined by examination of patient groups of sufficient number. This study aimed to evaluate the impact of admission diagnosis on GE in critically ill patients.

Methods: A retrospective review of patient demographics, diagnosis, intensive care unit (ICU) admission details, GE, and enteral feeding was performed on an unselected cohort of 132 mechanically ventilated patients (94 males, 38 females; age 54 +/- 1.2 years; admission Acute Physiology and Chronic Health Evaluation II [APACHE II] score of 22 +/- 1) who had undergone GE assessment by 13C-octanoic acid breath test. Delayed GE was defined as GE coefficient (GEC) of less than 3.20 and/or gastric half-emptying time (t50) of more than 140 minutes.

Results: Overall, 60% of the patients had delayed GE and a mean GEC of 2.9 +/- 0.1 and t50 of 163 +/- 7 minutes. On univariate analysis, GE correlated significantly with older age, higher admission APACHE II scores, longer length of stay in ICU prior to GE measurement, higher respiratory rate, higher FiO2 (fraction of inspired oxygen), and higher serum creatinine. After these factors were controlled for, there was a modest relationship between admission diagnosis and GE (r = 0.48; P = 0.02). The highest occurrence of delayed GE was observed in patients with head injuries, burns, multi-system trauma, and sepsis. Delayed GE was least common in patients with myocardial injury and non-gastrointestinal post-operative respiratory failure. Patients with delayed GE received fewer feeds and stayed longer in ICU and hospital compared to those with normal GE.

Conclusion: Admission diagnosis has a modest impact on GE in critically ill patients, even after controlling for factors such as age, illness severity, and medication, which are known to influence this function.

Figure 1

Summary of admission diagnoses in critically ill patients with normal or delayed gastric emptying (GE). *P < 0.05, versus normal GE; **P < 0.01, versus normal GE.

Figure 2

The impact of various admission diagnoses on gastric emptying variables, (a) t50 and (b) GEC, in critically ill patients. The bars represent median values of the gastric emptying variables. ^#P < 0.05, versus cardiac injury and non-gastrointestinal (GI) post-operative respiratory failure; ^##P < 0.01, versus cardiac injury and non-GI post-operative respiratory failure. GEC, gastric emptying coefficient; t50, gastric half-emptying time.