Chest
Critical Care ReviewGI Complications in Patients Receiving Mechanical Ventilation
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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2022, Small Animal Critical Care MedicineLow Incidence of Severe Gastrointestinal Complications in COVID-19 Patients Admitted to the Intensive Care Unit: A Large, Multicenter Study
2021, GastroenterologyCitation Excerpt :Similarly, a multicenter prospective cohort study from France that evaluated the rate of thrombotic complications in 150 patients with COVID-19 admitted to the ICU found that although 64 patients (42.7%) developed clinically relevant thrombotic complications, only 1 (0.7%) developed mesenteric ischemia.7 In conclusion, in this multicenter study involving a large number of ICU patients with COVID-19 across North America, we found a low incidence of severe gastrointestinal complications, consistent with rates reported in critically ill patients in general.8 Despite recent reports of increased risk of intestinal ischemia in patients with COVID-19, our study found a low rate of this complication and therefore provides reassurance that this phenomenon may not be as problematic as initially believed.
The effect of different doses of neostigmine plus metoclopramide on the gastric residual volume in patients under enteral nutrition in intensive care unit
2024, Anaesthesia, Pain and Intensive Care
This work is supported by the American Heart Association and Evanston-Northwestern Healthcare Research Institute.