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Gut Absorption Capacity in the Critically III

  • M. M. Berger
  • L. Soguel Alexander
  • R. L. Chioléro

Abstract

The intestine is characterized by a large mucosal surface, a complex vascular system, a variable anatomy, a dense neuronal network, a complex mesenteric lymphatic system, and an important gut-associated lymphoid tissue (GALT). Defining intestinal failure starts with the recognition of gut function (Table 1). Intestinal failure may be chronic or acute, may be intrinsic (direct insult to the gut) or extrinsic, with hemodynamic, septic, or pharmacological causes (as in the case of the opioid bowel syndrome). Intestinal failure involves motility disorders, alteration of the barrier function (increased permeability), and decreased absorption capacity. This chapter will focus on conditions observed in the critically ill patient.

Keywords

Enteral Nutrition Sequential Organ Failure Assessment Enteral Feeding Abdominal Compartment Syndrome Short Bowel Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Kreymann KG, Berger MM, Deutz NE, et al (2006) ESPEN Guidelines on enteral nutrition: Intensive care. Clin Nutr 25:210–223PubMedCrossRefGoogle Scholar
  2. 2.
    Jeppesen PB, Mortensen PB (2000) Intestinal failure defined by measurements of intestinal energy and wet weight absorption. Gut 46:701–706PubMedCrossRefGoogle Scholar
  3. 3.
    Deitch EA (2001) Role of the gut lymphatic system in multiple organ failure. Curr Opin Crit Care 7:92–98PubMedCrossRefGoogle Scholar
  4. 4.
    Deitch EA, Adams C, Lu Q, Xu DZ (2001) A time course study of the protective effect of mesenteric lymph duct ligation on hemorrhagic shock-induced pulmonary injury and the toxic effects of lymph from shocked rats on endothelial cell monolayer permeability. Surgery 129:39–47PubMedCrossRefGoogle Scholar
  5. 5.
    Fukatsu K, Sakamoto S, Hara E, et al (2006) Gut ischemia-reperfusion affects gut mucosal immunity: a possible mechanism for infectious complications after severe surgical insults. Crit Care Med 34:182–187PubMedCrossRefGoogle Scholar
  6. 6.
    Ikezawa F, Fukatsu K, Moriya T, et al (2006) Albumin infusion after reperfusion prevents gut ischemia-reperfusion-induced gut-associated lymphoid tissue atrophy. JPEN J Parenter Enteral Nutr 30:380–386PubMedGoogle Scholar
  7. 7.
    Jianfeng G, Weiming Z, Ning L, et al (2005) Serum citrulline is a simple quantitative marker for small intestinal enterocytes mass and absorption function in short bowel patients. J Surg Res 127:177–182PubMedCrossRefGoogle Scholar
  8. 8.
    Vincent JL, Moreno R, Takala J, et al (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710PubMedCrossRefGoogle Scholar
  9. 9.
    Malbrain ML, Cheatham ML, Kirkpatrick A, et al (2006) Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med 32:1722–1732PubMedCrossRefGoogle Scholar
  10. 10.
    Phillips SF (1997) The growth of knowledge in human digestion and absorption. Gastroenterology 112:1404–1405PubMedCrossRefGoogle Scholar
  11. 11.
    Venkateswaran RV, Charman SC, Goddard M, Large SR (2002) Lethal mesenteric ischaemia after cardiopulmonary bypass: a common complication? Europ J Cardio-Thor Surg 22:534–538CrossRefGoogle Scholar
  12. 12.
    Szinnai C, Mottet C, Gutzwiller JP, Drewe J, Beglinger C, Sieber CC (2001) Role of gender upon basal and postprandial systemic and splanchnic haemodynamics in humans. Scand J Gastroenterol 36(5):540–4PubMedCrossRefGoogle Scholar
  13. 13.
    Heymsfield SB, Casper K (1989) Congestive heart failure: clinical management by use of continuous nasoenteric feeding. Am J Clin Nutr 50:539–544PubMedGoogle Scholar
  14. 14.
    Paccagnella A, Calò M, Caenaro G, et al (1994) Cardiac cachexia: preoperative and postoperative nutrition management. JPEN J Parenter Enteral Nutr 18:409–416PubMedGoogle Scholar
  15. 15.
    Revelly JP, Tappy L, Berger MM, Gersbach P, Cayeux C, Chiolero R (2001) Metabolic, systemic and splanchnic hemodynamic responses to early enteral nutrition in postoperative patients treated for circulatory compromise. Intensive Care Med 27:540–547PubMedCrossRefGoogle Scholar
  16. 16.
    Berger MM, Berger-Gryllaki M, Wiesel PH, et al (2000) Gastrointestinal absorption after cardiac surgery. Crit Care Med 28:2217–2223PubMedCrossRefGoogle Scholar
  17. 17.
    Berger MM, Revelly JP, Cayeux MC, Chiolero RL (2005) Enteral nutrition in critically ill patients with severe hemodynamic failure after cardiopulmonary bypass. Clin Nutr 24:124–132PubMedCrossRefGoogle Scholar
  18. 18.
    Villet S, Chioléro RL, Bollmann MD, et al (2005) Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr 24:502–509PubMedCrossRefGoogle Scholar
  19. 19.
    Berger MM, Chioléro R (2002) Energy, trace element and vitamin requirements in major burns. Crit Care Shock 2:91–103Google Scholar
  20. 20.
    Zanetti G, Blanc DS, Federli I, et al (2007) Importation of Acinetobacter baumannii into a burn unit — A recurrent outbreak associated with widespread environmental contamination. Infect Control Hosp Epidemiol (in press)Google Scholar
  21. 21.
    Marvin RG, McKinley BA, McQuiggan M, Cocanour CS, Moore FA (2000) Nonocculsive bowel necrosis occuring in critically ill trauma patients receiving enteral nutrition manifest no reliable clinical signs for early detection. Am J Surg 179:7–12PubMedCrossRefGoogle Scholar
  22. 22.
    Uusaro A, Ruokonen E, Takala J (1996) Splanchnic oxygen transport after cardiac surgery: evidence for inadequate tissue perfusion after stabilization of hemodynamics. Intensive Care Med 22:26–33PubMedCrossRefGoogle Scholar
  23. 23.
    Hartley MN, Sarginson RF, Green CJ, et al (1992) Gastric pressure response to low dose dopamine infusion in normal man. Clin Nutr 11:23–29PubMedCrossRefGoogle Scholar
  24. 24.
    Balogh Z, McKinley BA, Cocanour CS, et al (2002) Secondary abdominal compartment syndrome is an elusive early complication of traumatic shock resuscitation. Am J Surg 184:538–543PubMedCrossRefGoogle Scholar
  25. 25.
    Ivy ME, Atweh NA, Palmer J, Possenti PP, Pineau M, D’Aiuto M (2000) Intra-abdominal hypertension and abdominal compartment syndrome in burn patients. J Trauma 49:387–391PubMedGoogle Scholar
  26. 26.
    Kinski MP, Milner SM, Button B, Dubick MA, Kramer GC (2000) Resuscitation of severe thermal injury with hypertonic saline dextran: Effects on peripheral and visceral edema in sheep. J Trauma 49:844–853Google Scholar
  27. 27.
    De-Souza DA, Greene LJ (2005) Intestinal permeability and systemic infections in critically ill patients: effect of glutamine. Crit Care Med 33:1125–1135PubMedCrossRefGoogle Scholar
  28. 28.
    Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P (2003) Canadian critical care clinical practice guideline committee: Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr 27: 355–373PubMedCrossRefGoogle Scholar
  29. 29.
    Kölbel CB, Rippel K, Klar H, van Ackern K, Friedler F (2000) Esophageal motility disorders in critically ill patients: a 24-hour manometric study. Intensive Care Med 26:1421–1427PubMedCrossRefGoogle Scholar
  30. 30.
    Chapman MJ, Fraser RJ, Kluger MT, Buist MD, De Nichilo DJ (2000) Erythromycin improves gastric emptying in critically ill patients intolerant of nasogastric feeding. Crit Care Med 28:2334–2337PubMedCrossRefGoogle Scholar
  31. 31.
    Heyland DK, Tougas G, King D, Cook DJ (1996) Impaired gastric emptying in mechanically ventilated, critically ill patients. Intensive Care Med 22:1339–1344PubMedCrossRefGoogle Scholar
  32. 32.
    Reignier J, Bensaid S, Perrin-Gachadoat D, Burdin M, Boiteau R, Tenaillon A (2002) Erythromycin and early enteral nutrition in mechanically ventilated patients. Crit Care Med 30: 1237–1241PubMedCrossRefGoogle Scholar
  33. 33.
    Berger MM, Bollmann MD, Revelly JP, et al (2002) Progression rate of self-propelled feeding tubes in critically ill patients. Intensive Care Med 28:1768–1774PubMedCrossRefGoogle Scholar
  34. 34.
    Lutgens LC, Blijlevens NM, Deutz NE, Donnelly JP, Lambin P, de Pauw BE (2005) Monitoring myeloablative therapy-induced small bowel toxicity by serum citrulline concentration: a comparison with sugar permeability tests. Cancer 103:191–199PubMedCrossRefGoogle Scholar
  35. 35.
    Blijlevens NM, van’t Land B, Donnelly JP, M’Rabet L, de Pauw BE (2004) Measuring mucosal damage induced by cytotoxic therapy. Support Care Cancer 12:227–233PubMedCrossRefGoogle Scholar
  36. 36.
    Silva E, DeBacker D, Creteur J, Vincent JL (1998) Effects of vasoactive drugs on gastric intra-mucosal pH. Crit Care Med 26:1749–1758PubMedCrossRefGoogle Scholar
  37. 37.
    Menzies IS, Zuckerman MJ, Nukajam WS, et al (1999) Geography of intestinal permeability and absorption. Gut 44:483–489PubMedCrossRefGoogle Scholar
  38. 38.
    Yoshida S, Matsui M, Shirouzu Y, Fujita H, Yamana H, Shirouzu K (1998) Effects of glutamine supplements and radiochemotherapy on systemic immune and gut barrier function in patients with advanced esophageal cancer. Ann Surg 227:157–166CrossRefGoogle Scholar
  39. 39.
    Clements JA, Heading RC, Nimmo WS, Prescott LF (1978) Kinetics of acetaminophen absorption and gastric emptying in man. Clin Pharmacol Ther 24:420–431PubMedGoogle Scholar
  40. 40.
    Marshall JC (1995) Clinical markers of gastrointestinal dysfunction. In: Rombeau JL, Takala J (eds) Gut Dysfunction in Critical Illness, vol. 26. Springer-Verlag, Berlin, pp 114–128Google Scholar
  41. 41.
    Berger MM, Werner D, Revelly JP, et al (2003) Serum paracetamol concentration: an alternative to X-rays to determine feeding tube location in critically ill. JPEN J Parenter Enteral Nutr 27:151–155PubMedGoogle Scholar
  42. 42.
    Crenn P, Vahedi K, Lavergne-Slove A, Cynober L, Matuchansky C, Messing B (2003) Plasma citrulline: A marker of enterocyte mass in villous atrophy-associated small bowel disease. Gastroenterology 124:1210–1219PubMedCrossRefGoogle Scholar
  43. 43.
    Chioléro RL, Revelly JP, Berger MM, Cayeux MC, Schneiter P, Tappy L (2003) Labeled acetate to assess intestinal absorption in critically ill patients. Crit Care Med 31:853–857PubMedCrossRefGoogle Scholar
  44. 44.
    Raguso CA, Dupertuis YM, Pichard C (2003) The role of visceral proteins in the nutritional assessment of intensive care unit patients. Curr Opin Clin Nutr Metab Care 6:211–216PubMedCrossRefGoogle Scholar
  45. 45.
    Berger MM, Revelly JP, Wasserfallen JB, et al (2006) Impact of a computerized information system on quality of nutritional support in the ICU. Nutrition 22:221–229PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media Inc. 2007

Authors and Affiliations

  • M. M. Berger
    • 1
  • L. Soguel Alexander
    • 1
  • R. L. Chioléro
    • 1
  1. 1.Department of Intensive Care and Burns CenterCHUV BH-08.660LausanneSwitzerland

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