Mechanisms underlying feed intolerance in the critically ill: Implications for treatment

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dc.contributor.authorDeane, A.
dc.contributor.authorChapman, M.
dc.contributor.authorFraser, R.
dc.contributor.authorBryant, L.
dc.contributor.authorBurgstad, C.
dc.contributor.authorNguyen, Q.
dc.date.issued2007
dc.description.abstractMalnutrition is associated with poor outcomes in critically ill patients. Although nutritional support is yet to be proven to improve mortality in non-malnourished critically ill patients, early enteral feeding is considered best practice. However, enteral feeding is often limited by delayed gastric emptying. The best method to clinically identify delayed gastric emptying and feed intolerance is unclear. Gastric residual volume (GRV) measured at the bedside is widely used as a surrogate marker for gastric emptying, but the value of GRV measurement has recently been disputed. While the mechanisms underlying delayed gastric emptying require further investigation, recent research has given a better appreciation of the pathophysiology. A number of pharmacological strategies are available to improve the success of feeding. Recent data suggest a combination of intravenous metoclopramide and erythromycin to be the most successful treatment, but novel drug therapies should be explored. Simpler methods to access the duodenum and more distal small bowel for feed delivery are also under investigation. This review summarises current understanding of the factors responsible for, and mechanisms underlying feed intolerance in critical illness, together with the evidence for current practices. Areas requiring further research are also highlighted.
dc.description.statementofresponsibilityDeane A, Chapman M, Fraser R, Bryant L, Burgstad C, Nguyen N
dc.identifier.citationWorld Journal of Gastroenterology, 2007; 13(29):3909-3917
dc.identifier.doi10.3748/wjg.v13.i29.3909
dc.identifier.issn1007-9327
dc.identifier.issn2219-2840
dc.identifier.orcidDeane, A. [0000-0002-7620-5577]
dc.identifier.orcidChapman, M. [0000-0003-0710-3283]
dc.identifier.orcidNguyen, Q. [0000-0002-1270-5441]
dc.identifier.urihttp://hdl.handle.net/2440/43560
dc.language.isoen
dc.publisherW J G Press
dc.source.urihttp://www.wjgnet.com/1007-9327/abstract_en.asp?f=3909&v=13
dc.subjectStomach
dc.subjectHumans
dc.subjectGastrointestinal Diseases
dc.subjectMalnutrition
dc.subjectCritical Illness
dc.subjectEnteral Nutrition
dc.subjectNutritional Support
dc.subjectRisk Factors
dc.subjectIntubation, Gastrointestinal
dc.subjectNutritional Requirements
dc.subjectGastrointestinal Motility
dc.subjectGastric Emptying
dc.subjectTime Factors
dc.titleMechanisms underlying feed intolerance in the critically ill: Implications for treatment
dc.typeJournal article
pubs.publication-statusPublished

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