title: Gastrointestinal failure in intensive care: a retrospective clinical study in three different intensive care units in Germany and Estonia.
abstract: BACKGROUND
  While gastrointestinal problems are common in ICU patients with multiple organ failure, gastrointestinal failure has not been given the consideration other organ systems receive. The aim of this study was to evaluate the incidence of gastrointestinal failure (GIF), to identify its risk factors, and to determine its association with ICU mortality.
  
  
  METHODS
  A retrospective analysis of adult patients (n = 2588) admitted to three different ICUs (two ICUs at the university hospital Charité-Universitätsmedizin Berlin, Germany and one at Tartu University Clinics, Estonia) during the year 2002 was performed. Data recorded in a computerized database were used in Berlin. In Tartu, the data documented in the patients' charts was retrospectively transferred into a similar database. GIF was defined as documented gastrointestinal problems (food intolerance, gastrointestinal haemorrhage, and/or ileus) in the patient data at any period of their ICU stay. ICU mortality, length of stay, and duration of mechanical ventilation were assessed as outcome parameters.
  
  
  RESULTS
  GIF was identified in 252 patients (9.7% of all patients). Only 20% of GIF patients were identifiable at admission. GIF was related to significantly higher mortality (43.7% vs. 5.3% in patients without GIF), as well as prolonged length of ICU stay (10 vs. 2 days) and mechanical ventilation (8 vs. 1 day), p < 0.001, respectively. Patients' profile (emergency surgical or medical), APACHE II and SOFA scores and the use of catecholamines at admission were identified as independent risk factors for the development of GIF. Development of GIF during ICU stay was an independent predictor for death.
  
  
  CONCLUSIONS
  Gastrointestinal failure represents a relevant clinical problem accompanied by an increased mortality, longer ICU stay and mechanical ventilation.
authors.affiliation: General Intensive Care Unit, Tartu University Clinics, Tartu, Estonia. annika.reintam@itk.ee
authors.forename: Annika
authors.initials: A
authors.lastname: Reintam
authors.forename: Pille
authors.initials: P
authors.lastname: Parm
authors.forename: Uwe
authors.initials: U
authors.lastname: Redlich
authors.forename: Liina-Mai
authors.initials: LM
authors.lastname: Tooding
authors.forename: Joel
authors.initials: J
authors.lastname: Starkopf
authors.forename: Friedrich
authors.initials: F
authors.lastname: Köhler
authors.forename: Claudia
authors.initials: C
authors.lastname: Spies
authors.forename: Hartmut
authors.initials: H
authors.lastname: Kern
mesh_terms: D018806:APACHE; D000328:Adult; D003422:Critical Care / Q000706:statistics & numerical data*; D016208:Databases, Factual; D004957:Estonia / Q000453:epidemiology; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005858:Germany / Q000453:epidemiology; D006305:Health Status Indicators; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome