Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/42811
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dc.contributor.authorNguyen, Q.en
dc.contributor.authorFraser, R.en
dc.contributor.authorChapman, M.en
dc.contributor.authorBryant, L.en
dc.contributor.authorHolloway, R.en
dc.contributor.authorYandell, R.en
dc.contributor.authorWishart, J.en
dc.contributor.authorFeinle-Bisset, C.en
dc.contributor.authorHorowitz, M.en
dc.date.issued2007en
dc.identifier.citationCritical Care Medicine, 2007; 35(1):82-88en
dc.identifier.issn0090-3493en
dc.identifier.issn1530-0293en
dc.identifier.urihttp://hdl.handle.net/2440/42811-
dc.description.abstractDelayed gastric emptying and intolerance to gastric feeding occur frequently in the critically ill. In these patients, gastric motor responses to nutrients are disturbed. Cholecystokinin (CCK) slows gastric emptying. The aim of this study was to determine plasma CCK concentrations during fasting and in response to small-intestine nutrient infusion in critically ill patients.Randomized, controlled trial.Level 3, mixed medical and surgical intensive care unit.A total of 31 mechanically ventilated, critically ill patients (23 men, 51 +/- 3 yrs) and 28 healthy subjects (21 men, 43 +/- 2 yrs).Subjects received two 60-min duodenal infusions of Ensure (complete balanced nutrition), at 1 and 2 kcal/min, in a randomized, single-blind fashion. The nutrient infusions were separated by a 2-hr "washout" period. Blood samples for measurement of plasma CCK concentrations were obtained immediately before and every 20 mins during nutrient infusion.Baseline and nutrient-stimulated plasma CCK concentrations were higher in critically ill patients compared with healthy subjects (p < .001). The magnitude of the rise in plasma CCK in response to nutrients was also greater in the critically ill (p < .01). Of the 23 patients who received enteral nutrition before the study, nine were intolerant of gastric feeding. In these patients, both the baseline plasma CCK concentration and the magnitude of CCK increase during nutrient infusions were greater than in patients with feed tolerance (p < .002). Impaired renal function was associated with an increased baseline CCK concentration but had no effect on the CCK response to nutrients.Both fasting and nutrient-stimulated plasma CCK concentrations are increased in critically ill patients, particularly in those with feed intolerance. This may provide a humoral mechanism for delayed gastric emptying seen in critical illness.en
dc.language.isoenen
dc.publisherLippincott Williams & Wilkinsen
dc.subjectDuodenum; Humans; Gastrointestinal Diseases; Kidney Diseases; Critical Illness; Cholecystokinin; Dietary Sucrose; Metabolic Clearance Rate; Respiration, Artificial; Enteral Nutrition; Length of Stay; Fasting; APACHE; Analysis of Variance; Single-Blind Method; Intubation, Gastrointestinal; Gastrointestinal Motility; Gastric Emptying; Time Factors; Adult; Female; Male; Feedback, Physiologicalen
dc.titleFeed intolerance in critical illness is associated with increased basal and nutrient-stimulated plasma cholecystokinin concentrationsen
dc.typeJournal articleen
dc.identifier.rmid0020070027en
dc.identifier.doi10.1097/01.CCM.0000250317.10791.6Cen
dc.identifier.pubid49357-
pubs.library.collectionMedicine publicationsen
pubs.verification-statusVerifieden
pubs.publication-statusPublisheden
dc.identifier.orcidChapman, M. [0000-0003-0710-3283]en
dc.identifier.orcidFeinle-Bisset, C. [0000-0001-6848-0125]en
Appears in Collections:Medicine publications

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