Chest
Volume 119, Issue 4, April 2001, Pages 1222-1241
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Critical Care Review
GI Complications in Patients Receiving Mechanical Ventilation

https://doi.org/10.1378/chest.119.4.1222Get rights and content

Mechanical ventilation (MV) can be lifesaving by maintaining gas exchange until the underlying disorders are corrected, but it is associated with numerous organ-system complications, which can significantly affect the outcome of critically ill patients. Like other organ systems, GI complications may be directly attributable to MV, but most are a reflection of the severity of the underlying disease that required intensive care. The interactions of the underlying critical illness and MV with the GI tract are complex and can manifest in a variety of clinical pictures. Incorporated in this review are discussions of the most prevalent GI complications associated with MV, and current diagnosis and management of these problems.

Section snippets

Interactions Between MV and Critical Illness

The interactions between critical illness and MV and their effect on the GI tract are complex. MV can contribute to the pathogenesis of GI problems in much the same way as critical illness. Unfortunately, the coexistence of critical illness makes it impossible to determine if MV is directly responsible for the GI complications seen in patients receiving MV. Thus, while the association exists, it is not clear whether there is a direct causal relationship between MV and GI complications. Table 2

GI Hemorrhage

Critically ill patients, especially those who are receiving MV, are prone to a spectrum of GI mucosal lesions that may result in GI hemorrhage. Acute respiratory failure requiring MV for > 48 h has been shown to be one of the two strongest independent risk factors for clinically important GI bleeding in the ICU.34,35 It is not clear, however, whether MV contributes the pathophysiology of GI bleeding or if it is simply a marker of severity of critical illness.

Hypomotility

GI hypomotility manifesting as decreased bowel sounds or abdominal distention is common and has been reported in up to half of patients with respiratory failure.6 In a recent multicenter study, Montejo119 prospectively investigated the frequency of nonhemorrhagic GI complications in 400 ICU patients receiving enteral feeding. Almost two thirds of subjects developed one or more GI complications; high gastric residuals (39%) and constipation (15.7%) were most common. Patients with GI

Summary

MV is a lifesaving tool, but it is not without limitations. There are numerous GI complications seen in critically ill patients receiving MV. Although it remains unclear if these complications are the direct effect of MV, current knowledge suggests that MV may contribute to physiologic changes that may impair the function of the GI tract. These changes can lead to common complications, such as SRMD and associated GI hemorrhage and hypomotility, some of which can occur in up to 50% of patients

ACKNOWLEDGMENT

The authors thank Ali Keshavarzian, MD (Chief, Division of Digestive Diseases at Rush Presbyterian-St. Luke's Medical Center, Chicago, IL), for his critical review of the article.

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