title: Gastric feeding intolerance is not caused by mucosal ischemia measured by intragastric air tonometry in the critically ill.
abstract: Gastric mucosal ischemia may be a risk factor for gastrointestinal intolerance to early feeding in the critically ill.
  
  
  
  To study intragastric PCO2 air tonometry and gastric residual volumes (GRV) before and after the start of gastric feeding.
  
  
  
  This is a two-center study in intensive care units of a university and teaching hospital. Twenty-nine critically ill, consecutive and consenting patients scheduled to start gastric feeding were studied after insertion of a gastric tonometry catheter and prior to and after start of gastric feeding (500 ml over 1 h), when clinically indicated.
  
  
  
  Blood gasometry and intragastric tonometry were performed prior to and 2 h after gastric feeding. The intragastric to arterial PCO2 gap (normal <8 mm Hg) was elevated in 41% of patients prior to feeding and measured (mean ± standard deviation) 13 ± 20 and 16 ± 23 mm Hg in patients with normal (<100 ml, 42 ± 34 ml, n = 19) and elevated GRV (250 ± 141 ml, n = 10, P = 0.75), respectively. After feeding, the gradient did not increase and measured 27 ± 25 and 23 ± 34 mm Hg, respectively (P = 0.80).
  
  
  
  Gastric mucosal ischemia is not a major risk factor for intolerance to early gastric feeding in the critically ill.
authors.affiliation: Department of Intensive Care Medisch Centrum Haaglanden and Bronovo Ziekenhuis, Den Haag, Rotterdam, The Netherlands.
authors.forename: Jörn O
authors.initials: JO
authors.lastname: Streefkerk
authors.affiliation: Medisch Spectrum Twente, Enschede, Rotterdam, The Netherlands.
authors.forename: Albertus
authors.initials: A
authors.lastname: Beishuizen
authors.affiliation: Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: a.b.j.groeneveld@erasmusmc.nl.
authors.forename: A B Johan
authors.initials: AB
authors.lastname: Groeneveld
mesh_terms: D000368:Aged; D016638:Critical Illness; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D000073923:Food Intolerance / Q000453:epidemiology / Q000209:etiology*; D005526:Food, Formulated / Q000009:adverse effects*; D005753:Gastric Mucosa / Q000098:blood supply*; D005756:Gastritis / Q000453:epidemiology / Q000209:etiology*; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D000075082:Proof of Concept Study; D015203:Reproducibility of Results; D012307:Risk Factors
keywords: Critically ill; Enteral nutrition intolerance; Gastric ischemia; Gastric residuals; Intragastric tonometry; PCO(2) gap