title: Critical Illness Is Associated With Impaired Gallbladder Emptying as Assessed by 3D Ultrasound.
abstract: OBJECTIVE
  To quantify gallbladder dysfunction during critical illness.
  
  
  METHODS
  Prospective observational comparison study of nutrient-stimulated gallbladder emptying in health and critical illness.
  
  
  METHODS
  Single-centre mixed medical/surgical ICU.
  
  
  METHODS
  Twenty-four mechanically ventilated critically ill patients suitable to receive enteral nutrition were compared with 12 healthy subjects.
  
  
  METHODS
  Participants were studied after an 8-hour fast. Between 0 and 120 minutes, high-fat nutrient (20% intralipid) was infused via a postpyloric catheter into the duodenum at 2 kcal/min.
  
  
  RESULTS
  Three-dimensional images of the gallbladder were acquired at 30-minute intervals from -30 to 180 minutes. Ejection fraction (%) was calculated as changes between 0 and 120 minutes. Blood samples were obtained at 30-minute intervals for plasma cholecystokinin. Data are mean (SD) or median [interquartile range]. In the critically ill, fasting gallbladder volumes (critically ill, 61 mL [36-100 mL] vs healthy, 22 mL [15-25] mL; p < 0.001] and wall thickness (0.45 mm [0.15 mm] vs 0.26 mm [0.08 mm]; p < 0.001] were substantially greater, and sludge was evident in the majority of patients (71% vs 0%). Nutrient-stimulated emptying was incomplete in the critically ill after 120 minutes but was essentially complete in the healthy individuals (22 mL [9-66 mL] vs 4 mL [3-5 mL]; p < 0.01]. In five critically ill patients (21%), there was no change in gallbladder volume in response to nutrient, and overall ejection fraction was reduced in the critically ill (50% [8-83%] vs 77 [72-84%]; p = 0.01]. There were no differences in fasting or incremental cholecystokinin concentrations.
  
  
  CONCLUSIONS
  Fasted critically ill patients have larger, thicker-walled gallbladders than healthy subjects and nutrient-stimulated gallbladder emptying is impaired with "gallbladder paresis" occurring in approximately 20%.
authors.affiliation: 1Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.2Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, SA, Australia.3Department of Medicine, Haukeland University Hospital, Bergen, Norway.4Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Plummer
authors.forename: Palash
authors.initials: P
authors.lastname: Kar
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Cousins
authors.forename: Trygve
authors.initials: T
authors.lastname: Hausken
authors.forename: Kylie
authors.initials: K
authors.lastname: Lange
authors.forename: Marianne J
authors.initials: MJ
authors.lastname: Chapman
authors.forename: Karen L
authors.initials: KL
authors.lastname: Jones
authors.forename: Michael
authors.initials: M
authors.lastname: Horowitz
authors.forename: Adam M
authors.initials: AM
authors.lastname: Deane
mesh_terms: D000328:Adult; D000368:Aged; D002766:Cholecystokinin / Q000097:blood; D016638:Critical Illness; D004750:Enteral Nutrition; D005215:Fasting; D005260:Female; D016473:Gallbladder Emptying / Q000502:physiology*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014463:Ultrasonography
chemical_list: D002766:Cholecystokinin