title: Prolonged gastrointestinal dysfunction in critically ill patients.
abstract: OBJECTIVE
  We aimed to investigate the prevalence and independent predictors of prolonged gastrointestinal dysfunction in critically ill patients admitted to the intensive care unit.
  
  
  METHODS
  Retrospective and observational cohort study performed in a mixed 24 beds intensive care unit in a tertiary center. Patients admitted in the intensive care unit between August 2003 and January 2004, who had a length of stay in the intensive care unit greater than 4 days were enrolled. Gastrointestinal function was evaluated daily according to a classification that considered physical examination (bowel sounds or distension) and the nutritional support progress.
  
  
  RESULTS
  Were included 128 patients. The mean age was 56 ± 19 years, 63.3% were male and 77.3% were surgical patients. Prolonged gastrointestinal dysfunction occurred in 35% of patients, with prevalence 3.3 times higher in surgical patients (27%) than in medical patients (8%). Endoscopies were performed in 38 patients (29.7%), and in three quarters of them erosive lesions and or bleeding were observed. Gastrointestinal dysfunction was more frequent in patients presenting moderate or severe edema (51%) than in patients without edema (22.5%) (p<0.05). In the logistic regression analysis, a serum lactate level higher than 5.2 mEq/L (RR 6.69 95%CI 15-38.7, P = 0.034) and the presence of a low oxygenation index (RR 12.4 95%CI 2.18-70.8, p = 0.005) were predictive of gastrointestinal dysfunction.
  
  
  CONCLUSIONS
  Prolonged gastrointestinal dysfunction was highly prevalent in this heterogeneous population of critically ill patients. Admission high serum lactate levels and a low oxygenation index were predictive of prolonged gastrointestinal dysfunction.
authors.affiliation: Faculdade de Medicina de Rio Preto, Hospital de Base, São Jose do Rio Preto, São Paulo, Brasil.
authors.forename: Suzana Margareth
authors.initials: SM
authors.lastname: Lobo
authors.affiliation: Faculdade de Medicina de Rio Preto, Hospital de Base, São José do Rio Preto, São Paulo, Brasil.
authors.forename: Amanda Lucia Diaz
authors.initials: AL
authors.lastname: Miranda