Gastrointestinal Dysfunction and Feeding Intolerance in Critical Illness: Do We Need an Objective Scoring System?

Stephen A. McClave, Jill Gualdoni, Annie Nagengast, Luis S. Marsano, Kathryn Bandy, Robert G. Martindale

Research output: Contribution to journalReview article

Abstract

Purpose of Review: Efforts to provide early enteral nutrition in critical illness are thwarted by gastrointestinal dysfunction and feeding intolerance. While many of the signs and symptoms of this dysfunction reflect gastroparesis and intestinal dysmotility, other symptoms which may or may not be related are often included such as diarrhea, bleeding, and intra-abdominal hypertension. This paper discusses the need to monitor tolerance of nutritional therapy in the critical care setting and reviews the results of those clinical trials which have helped establish objective measures, define feeding intolerance, and provide a tool to guide continued delivery of the enteral regimen. Recent Findings: While definitions vary, the presence of gastrointestinal dysfunction and feeding intolerance correlates with adverse clinical outcomes, including prolonged duration of mechanical ventilation, greater length of stay in the intensive care unit, and increased mortality. Summary: Despite their prognostic value, it is not clear to what extent these scoring systems should direct nutritional therapy. The clinician should be astute in the careful selection of monitors, in identifying and addressing signs and symptoms of intolerance, and by responding appropriately with feeding strategies that are effective and safe. Early enteral feeding in critical illness has been shown to be optimized by following protocols which allow monitoring patient tolerance while providing individualized care.

Original languageEnglish (US)
Article number1
JournalCurrent gastroenterology reports
Volume22
Issue number1
DOIs
StatePublished - Jan 1 2020

Fingerprint

Enteral Nutrition
Critical Illness
Signs and Symptoms
Intra-Abdominal Hypertension
Gastroparesis
Physiologic Monitoring
Critical Care
Artificial Respiration
Small Intestine
Intensive Care Units
Diarrhea
Length of Stay
Clinical Trials
Hemorrhage
Mortality
Therapeutics

Keywords

  • Enteral nutrition
  • Feeding intolerance
  • Gastric residual volumes
  • Gastrointestinal failure
  • Gastrointestinal tolerance

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Gastrointestinal Dysfunction and Feeding Intolerance in Critical Illness : Do We Need an Objective Scoring System? / McClave, Stephen A.; Gualdoni, Jill; Nagengast, Annie; Marsano, Luis S.; Bandy, Kathryn; Martindale, Robert G.

In: Current gastroenterology reports, Vol. 22, No. 1, 1, 01.01.2020.

Research output: Contribution to journalReview article

McClave, Stephen A. ; Gualdoni, Jill ; Nagengast, Annie ; Marsano, Luis S. ; Bandy, Kathryn ; Martindale, Robert G. / Gastrointestinal Dysfunction and Feeding Intolerance in Critical Illness : Do We Need an Objective Scoring System?. In: Current gastroenterology reports. 2020 ; Vol. 22, No. 1.
@article{9ac53b3512434fd282c24d6d5e376f9c,
title = "Gastrointestinal Dysfunction and Feeding Intolerance in Critical Illness: Do We Need an Objective Scoring System?",
abstract = "Purpose of Review: Efforts to provide early enteral nutrition in critical illness are thwarted by gastrointestinal dysfunction and feeding intolerance. While many of the signs and symptoms of this dysfunction reflect gastroparesis and intestinal dysmotility, other symptoms which may or may not be related are often included such as diarrhea, bleeding, and intra-abdominal hypertension. This paper discusses the need to monitor tolerance of nutritional therapy in the critical care setting and reviews the results of those clinical trials which have helped establish objective measures, define feeding intolerance, and provide a tool to guide continued delivery of the enteral regimen. Recent Findings: While definitions vary, the presence of gastrointestinal dysfunction and feeding intolerance correlates with adverse clinical outcomes, including prolonged duration of mechanical ventilation, greater length of stay in the intensive care unit, and increased mortality. Summary: Despite their prognostic value, it is not clear to what extent these scoring systems should direct nutritional therapy. The clinician should be astute in the careful selection of monitors, in identifying and addressing signs and symptoms of intolerance, and by responding appropriately with feeding strategies that are effective and safe. Early enteral feeding in critical illness has been shown to be optimized by following protocols which allow monitoring patient tolerance while providing individualized care.",
keywords = "Enteral nutrition, Feeding intolerance, Gastric residual volumes, Gastrointestinal failure, Gastrointestinal tolerance",
author = "McClave, {Stephen A.} and Jill Gualdoni and Annie Nagengast and Marsano, {Luis S.} and Kathryn Bandy and Martindale, {Robert G.}",
year = "2020",
month = "1",
day = "1",
doi = "10.1007/s11894-019-0736-z",
language = "English (US)",
volume = "22",
journal = "Current Gastroenterology Reports",
issn = "1522-8037",
publisher = "Current Medicine Group",
number = "1",

}

TY - JOUR

T1 - Gastrointestinal Dysfunction and Feeding Intolerance in Critical Illness

T2 - Do We Need an Objective Scoring System?

AU - McClave, Stephen A.

AU - Gualdoni, Jill

AU - Nagengast, Annie

AU - Marsano, Luis S.

AU - Bandy, Kathryn

AU - Martindale, Robert G.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Purpose of Review: Efforts to provide early enteral nutrition in critical illness are thwarted by gastrointestinal dysfunction and feeding intolerance. While many of the signs and symptoms of this dysfunction reflect gastroparesis and intestinal dysmotility, other symptoms which may or may not be related are often included such as diarrhea, bleeding, and intra-abdominal hypertension. This paper discusses the need to monitor tolerance of nutritional therapy in the critical care setting and reviews the results of those clinical trials which have helped establish objective measures, define feeding intolerance, and provide a tool to guide continued delivery of the enteral regimen. Recent Findings: While definitions vary, the presence of gastrointestinal dysfunction and feeding intolerance correlates with adverse clinical outcomes, including prolonged duration of mechanical ventilation, greater length of stay in the intensive care unit, and increased mortality. Summary: Despite their prognostic value, it is not clear to what extent these scoring systems should direct nutritional therapy. The clinician should be astute in the careful selection of monitors, in identifying and addressing signs and symptoms of intolerance, and by responding appropriately with feeding strategies that are effective and safe. Early enteral feeding in critical illness has been shown to be optimized by following protocols which allow monitoring patient tolerance while providing individualized care.

AB - Purpose of Review: Efforts to provide early enteral nutrition in critical illness are thwarted by gastrointestinal dysfunction and feeding intolerance. While many of the signs and symptoms of this dysfunction reflect gastroparesis and intestinal dysmotility, other symptoms which may or may not be related are often included such as diarrhea, bleeding, and intra-abdominal hypertension. This paper discusses the need to monitor tolerance of nutritional therapy in the critical care setting and reviews the results of those clinical trials which have helped establish objective measures, define feeding intolerance, and provide a tool to guide continued delivery of the enteral regimen. Recent Findings: While definitions vary, the presence of gastrointestinal dysfunction and feeding intolerance correlates with adverse clinical outcomes, including prolonged duration of mechanical ventilation, greater length of stay in the intensive care unit, and increased mortality. Summary: Despite their prognostic value, it is not clear to what extent these scoring systems should direct nutritional therapy. The clinician should be astute in the careful selection of monitors, in identifying and addressing signs and symptoms of intolerance, and by responding appropriately with feeding strategies that are effective and safe. Early enteral feeding in critical illness has been shown to be optimized by following protocols which allow monitoring patient tolerance while providing individualized care.

KW - Enteral nutrition

KW - Feeding intolerance

KW - Gastric residual volumes

KW - Gastrointestinal failure

KW - Gastrointestinal tolerance

UR - http://www.scopus.com/inward/record.url?scp=85077530227&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85077530227&partnerID=8YFLogxK

U2 - 10.1007/s11894-019-0736-z

DO - 10.1007/s11894-019-0736-z

M3 - Review article

C2 - 31912312

AN - SCOPUS:85077530227

VL - 22

JO - Current Gastroenterology Reports

JF - Current Gastroenterology Reports

SN - 1522-8037

IS - 1

M1 - 1

ER -