Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems.
OBJECTIVE
Acute gastrointestinal (GI) dysfunction and failure have been increasingly recognized in critically ill patients. The variety of definitions proposed in the past has led to confusion and difficulty in comparing one study to another. An international working group convened to standardize the definitions for acute GI failure and GI symptoms and to review the therapeutic options.


METHODS
The Working Group on Abdominal Problems (WGAP) of the European Society of Intensive Care Medicine (ESICM) developed the definitions for GI dysfunction in intensive care patients on the basis of the available evidence and current understanding of the pathophysiology.


RESULTS
Definitions for acute gastrointestinal injury (AGI) with its four grades of severity, as well as for feeding intolerance syndrome and GI symptoms (e.g. vomiting, diarrhoea, paralysis, high gastric residual volumes) are proposed. AGI is a malfunctioning of the GI tract in intensive care patients due to their acute illness. AGI grade I = increased risk of developing GI dysfunction or failure (a self-limiting condition); AGI grade II = GI dysfunction (a condition that requires interventions); AGI grade III = GI failure (GI function cannot be restored with interventions); AGI grade IV = dramatically manifesting GI failure (a condition that is immediately life-threatening). Current evidence and expert opinions regarding treatment of acute GI dysfunction are provided.


CONCLUSIONS
State-of-the-art definitions for GI dysfunction with gradation as well as management recommendations are proposed on the basis of current medical evidence and expert opinion. The WGAP recommends using these definitions for clinical and research purposes.
Clinic of Anaesthesiology and Intensive Care, University of Tartu, Puusepa 8, 51014 Tartu, Estonia. annika.reintam@ut.ee
Annika
A
Reintam Blaser
Manu L N G
ML
Malbrain
Joel
J
Starkopf
Sonja
S
Fruhwald
Stephan M
SM
Jakob
Jan
J
De Waele
Jan-Peter
JP
Braun
Martijn
M
Poeze
Claudia
C
Spies
D003422:Critical Care / Q000379:methods / Q000592:standards*; D016638:Critical Illness / Q000628:therapy*; D005767:Gastrointestinal Diseases / Q000145:classification / Q000503:physiopathology / Q000628:therapy*; D041981:Gastrointestinal Tract / Q000502:physiology / Q000503:physiopathology*; D006801:Humans; D012720:Severity of Illness Index; D009626:Terminology as Topic