Gastrointestinal dysfunction in the critically ill: a systematic scoping review and research agenda proposed by the Section of Metabolism, Endocrinology and Nutrition of the European Society of Intensive Care Medicine
Critical Care, vol. 24, pp. 224
Abstract
BACKGROUND: Gastrointestinal (GI) dysfunction is frequent in the critically ill but can be overlooked as a result of the lack of standardization of the diagnostic and therapeutic approaches. We aimed to develop a research agenda for GI dysfunction for future research. We systematically reviewed the current knowledge on a broad range of subtopics from a specific viewpoint of GI dysfunction, highlighting the remaining areas of uncertainty and suggesting future studies. METHODS: This systematic scoping review and research agenda was conducted following successive steps: (1) identify clinically important subtopics within the field of GI function which warrant further research; (2) systematically review the literature for each subtopic using PubMed, CENTRAL and Cochrane Database of Systematic Reviews; (3) summarize evidence for each subtopic; (4) identify areas of uncertainty; (5) formulate and refine study proposals that address these subtopics; and (6) prioritize study proposals via sequential voting rounds. RESULTS: Five major themes were identified: (1) monitoring, (2) associations between GI function and outcome, (3) GI function and nutrition, (4) management of GI dysfunction and (5) pathophysiological mechanisms. Searches on 17 subtopics were performed and evidence summarized. Several areas of uncertainty were identified, six of them needing consensus process. Study proposals ranked among the first ten included: prevention and management of diarrhoea; management of upper and lower feeding intolerance, including indications for post-pyloric feeding and opioid antagonists; acute gastrointestinal injury grading as a bedside tool; the role of intra-abdominal hypertension in the development and monitoring of GI dysfunction and in the development of non-occlusive mesenteric ischaemia; and the effect of proton pump inhibitors on the microbiome in critical illness. CONCLUSIONS: Current evidence on GI dysfunction is scarce, partially due to the lack of precise definitions. The use of core sets of monitoring and outcomes are required to improve the consistency of future studies. We propose several areas for consensus process and outline future study projects.
Authors 25
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Annika Reintam Blaser corresponding
Université Libre de Bruxelles · Erasmus Hospital · Luzerner Kantonsspital · University of Tartu
Affiliation as printed
Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia. annika.reintam.blaser@ut.ee
Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland. annika.reintam.blaser@ut.ee
Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Université Libre de Bruxelles · Medical University of Graz · Erasmus Hospital
Affiliation as printed
Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
Department of Anaesthesiology and Intensive Care Medicine, Division of Anesthesiology for Cardiovascular Surgery and Intensive Care Medicine, Medical University of Graz, Graz, Austria
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Medical University of Graz · KU Leuven
Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, Division of Anesthesiology for Cardiovascular Surgery and Intensive Care Medicine, Medical University of Graz, Graz, Austria
Department of Medical Intensive Care, Katholieke Universiteit Leuven, Leuven, Belgium
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Karolinska Institutet · KU Leuven
Affiliation as printed
Department of Medical Intensive Care, Katholieke Universiteit Leuven, Leuven, Belgium
Department of Anaesthesiology and Intensive Care Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden
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Karolinska Institutet · RWTH Aachen University
Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden
Department of Intensive Care Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany
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RWTH Aachen University · KU Leuven
Affiliation as printed
Cardiovascular Critical Care & Anesthesia Research and Evaluation (3CARE), Medical Faculty, RWTH Aachen University, Aachen, Germany
Department of Intensive Care Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany
Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
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Tartu University Hospital · KU Leuven
Affiliation as printed
Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia
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Tartu University Hospital · Ziekenhuis Gelderse Vallei · University of Tartu
Affiliation as printed
Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia
Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia
Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
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Karolinska Institutet · Ziekenhuis Gelderse Vallei
Affiliation as printed
Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
Department of Anesthesiology and Intensive Care, CLINTEC, Karolinska Institutet, Stockholm, Sweden
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University Hospital of Bern · Karolinska Institutet
Affiliation as printed
Department of Anesthesiology and Intensive Care, CLINTEC, Karolinska Institutet, Stockholm, Sweden
Department of Intensive Care Medicine, Inselspital, Bern, Switzerland
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University of Bern · University Hospital of Bern
Affiliation as printed
Department of Intensive Care Medicine, Inselspital, Bern, Switzerland
University of Bern, Bern, Switzerland
Department of Intensive Care, Hospital Interzonal General de Agudos General San Martín, La Plata, Argentina
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Guy's and St Thomas' NHS Foundation Trust
Affiliation as printed
Department of Intensive Care, Hospital Interzonal General de Agudos General San Martín, La Plata, Argentina
Departments of Critical Care and Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
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King's College London · Guy's and St Thomas' NHS Foundation Trust · University Hospital Schleswig-Holstein
Affiliation as printed
Centre for Human and Applied Physiological Sciences, King's College London, London, UK
Departments of Critical Care and Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
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University Hospital Schleswig-Holstein
Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
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University Hospital Schleswig-Holstein
Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
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University Hospital Schleswig-Holstein · Universitätsmedizin Göttingen · University of Göttingen
Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
Department of Anaesthesiology, Universitätsmedizin Göttingen, Göttingen, Germany
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Universitätsmedizin Göttingen · University of Göttingen · KU Leuven
Affiliation as printed
Department of Anaesthesiology, Universitätsmedizin Göttingen, Göttingen, Germany
Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
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RWTH Aachen University · KU Leuven
Affiliation as printed
Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
Department of Intensive Care Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany
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Université Libre de Bruxelles · Erasmus Hospital · RWTH Aachen University
Affiliation as printed
Department of Intensive Care Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany
Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Université Libre de Bruxelles · Erasmus Hospital · University Medical Center Hamburg-Eppendorf
Affiliation as printed
Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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University of Münster · Centre Hospitalier Universitaire Vaudois · University Medical Center Hamburg-Eppendorf
Affiliation as printed
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Department of Medicine B, University of Münster, Münster, Germany
Service of Adult Intensive Care Medicine and Burns, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Centre Hospitalier Universitaire Vaudois · Amsterdam University Medical Centers · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Service of Adult Intensive Care Medicine and Burns, Lausanne University Hospital (CHUV), Lausanne, Switzerland
Department of Intensive Care, Amsterdam University Medical Center, VUMC, Amsterdam, The Netherlands
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King Saud bin Abdulaziz University for Health Sciences · King Abdullah International Medical Research Center · Amsterdam University Medical Centers · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Department of Intensive Care, Amsterdam University Medical Center, VUMC, Amsterdam, The Netherlands
College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) and King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
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The Royal Melbourne Hospital · The University of Melbourne · King Saud bin Abdulaziz University for Health Sciences · King Abdullah International Medical Research Center
Affiliation as printed
College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) and King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
The University of Melbourne, Department of Medicine, Royal Melbourne Hospital, Parkville, Victoria, 3050, Australia
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The Royal Melbourne Hospital · The University of Melbourne
Affiliation as printed
The University of Melbourne, Department of Medicine, Royal Melbourne Hospital, Parkville, Victoria, 3050, Australia
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