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Review
. 2021 Apr 1;27(2):141-146.
doi: 10.1097/MCC.0000000000000813.

Gut dysfunction in the ICU: diagnosis and management

Lee-Anne S Chapple  1   2 , Mark P Plummer  3   4 , Marianne J Chapman  1   2
Affiliations
Review

Gut dysfunction in the ICU: diagnosis and management

Lee-Anne S Chapple et al. Curr Opin Crit Care. .

Abstract

Purpose of review: Progress has been made in our understanding of gut dysfunction in critical illness. This review will outline new findings and give perspectives based on previous knowledge and concurrent advances in nutrition.

Recent findings: The relationship between gut dysfunction and poor outcomes in critical illness has received considerable interest. It remains uncertain whether gut dysfunction is merely a marker of illness severity or if it is directly responsible for prolonged critical illness and increased mortality. This relationship is difficult to ascertain given there is no agreed method for identification and quantification; biomarkers such as intestinal fatty acid binding protein and citrulline show promise but require further study. Recent studies have investigated strategies to deliver enteral nutrition targets with impacts on gut function, including high calorie or protein formulae, intermittent regimes and novel prokinetics.

Summary: Gut dysfunction is associated with poor outcomes, but it remains uncertain whether strategies to improve gut function will influence survival and recovery.

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References

    1. Sierp EL, Kurmis R, Lange K, et al. Nutrition and gastrointestinal dysmotility in critically ill burn patients: a retrospective observational study. JPEN J Parenter Enteral Nutr 2020; [Epub ahead of print].
    1. Chapple LS, Weinel LM, Abdelhamid YA, et al. Observed appetite and nutrient intake three months after icu discharge. Clin Nutr 2019; 38:1215–1220.
    1. Di Bartolomeo AE, Chapman MJ, Zaknic AV, et al. Comparative effects on glucose absorption of intragastric and postpyloric nutrient delivery in the critically ill. Crit Care 2012; 16:R167.
    1. Ali Abdelhamid Y, Cousins CE, Sim JA, et al. Effect of critical illness on triglyceride absorption. JPEN J Parenter Enteral Nutr 2015; 39:966–972.
    1. Burgstad CM, Besanko LK, Deane AM, et al. Sucrose malabsorption and impaired mucosal integrity in enterally fed critically ill patients: a prospective cohort observational study. Crit Care Med 2013; 41:1221–1228.

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