Gastric emptying and the organization of antro-duodenal pressures in the critically ill.
The motor dysfunctions underlying delayed gastric emptying (GE) in critical illness are poorly defined. Our aim was to characterize the relationship between antro-duodenal (AD) motility and GE in critically ill patients. AD pressures were recorded in 15 mechanically ventilated patients and 10 healthy volunteers for 2 h (i) during fasting, (ii) following an intragastric nutrient bolus with concurrent assessment of GE using the (13)C-octanoate breath test and (iii) during duodenal nutrient infusion. Propagated waves were characterized by length and direction of migration. Critical illness was associated with: (i) slower GE (GEC: 3.47 +/- 0.1 vs 2.99 +/- 0.2; P = 0.046), (ii) fewer antegrade (duodenal: 44%vs 83%, AD: 16%vs 83%; P < 0.001) and more retrograde (duodenal: 46%vs 12%, AD: 38%vs 4%; P < 0.001) waves, (iii) shorter wave propagation (duodenal: 4.7 +/- 0.3 vs 6.0 +/- 0.4 cm; AD: 7.7 +/- 0.6 vs 10.9 +/- 0.9 cm; P = 0.004) and (iv) a close correlation between GE with the percentage of propagated phase 3 waves that were antegrade (r = 0.914, P = 0.03) and retrograde (r = -0.95, P = 0.014). In critical illness, the organization of AD pressure waves is abnormal and associated with slow GE.
Chapman
M J
MJ
Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia. marianne.chapman@health.sa.gov.au
Fraser
R J
RJ
Bryant
L K
LK
Vozzo
R
R
Nguyen
N Q
NQ
Tam
W
W
Zacharakis
B
B
Davidson
G
G
Butler
R
R
Horowitz
M
M
D000328:Adult; D016638:Critical Illness; D004386:Duodenum / Q000503:physiopathology*; D005746:Gastric Emptying; D006801:Humans; D008365:Manometry; D010528:Peristalsis; D011312:Pressure; D011706:Pyloric Antrum / Q000503:physiopathology*; D012016:Reference Values; D012121:Respiration, Artificial