open access

Vol 50, No 1 (2018)
Review articles
Published online: 2017-11-19
Submitted: 2017-10-10
Accepted: 2017-11-15
Get Citation

Perioperative gastrointestinal problems in the ICU

Annika Reintam Blaser, Joel Starkopf, Pieter-Jan Moonen, Manu L.N.G. Malbrain, Heleen M. Oudemans-van Straaten
DOI: 10.5603/AIT.a2017.0064
·
Pubmed: 29152709
·
Anaesthesiol Intensive Ther 2018;50(1):59-71.

open access

Vol 50, No 1 (2018)
Review articles
Published online: 2017-11-19
Submitted: 2017-10-10
Accepted: 2017-11-15

Abstract

Gastrointestinal (GI) problems after surgery are common and are not limited to patients undergoing abdominal
surgery. GI function is complicated to monitor and is not included in organ dysfunction scores widely used in the
ICUs. In most cases, it recovers after surgery, if systemic and local inflammation and perfusion improve, gut oedema
resolves, and analgosedation is reduced. However, perioperative GI problems may have severe consequences and
increase the risk of death if not recognized and managed in a timely manner. Careful risk evaluation followed by
a complex structured assessment and appropriate management of GI symptoms should minimize the potentially
severe consequences and thereby possibly improve outcome.
In the current review, we summarize common non-specific perioperative GI problems and some specific surgery-related
abdominal problems, address identification of patients at risk of GI problems, and give suggestions for perioperative
GI management.

Abstract

Gastrointestinal (GI) problems after surgery are common and are not limited to patients undergoing abdominal
surgery. GI function is complicated to monitor and is not included in organ dysfunction scores widely used in the
ICUs. In most cases, it recovers after surgery, if systemic and local inflammation and perfusion improve, gut oedema
resolves, and analgosedation is reduced. However, perioperative GI problems may have severe consequences and
increase the risk of death if not recognized and managed in a timely manner. Careful risk evaluation followed by
a complex structured assessment and appropriate management of GI symptoms should minimize the potentially
severe consequences and thereby possibly improve outcome.
In the current review, we summarize common non-specific perioperative GI problems and some specific surgery-related
abdominal problems, address identification of patients at risk of GI problems, and give suggestions for perioperative
GI management.

Get Citation

Keywords

perioperative, postoperative, abdominal surgery, gastrointestinal function, gastrointestinal failure, acute gastrointestinal injury, abdominal problems, critical illness

About this article
Title

Perioperative gastrointestinal problems in the ICU

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 50, No 1 (2018)

Pages

59-71

Published online

2017-11-19

DOI

10.5603/AIT.a2017.0064

Pubmed

29152709

Bibliographic record

Anaesthesiol Intensive Ther 2018;50(1):59-71.

Keywords

perioperative
postoperative
abdominal surgery
gastrointestinal function
gastrointestinal failure
acute gastrointestinal injury
abdominal problems
critical illness

Authors

Annika Reintam Blaser
Joel Starkopf
Pieter-Jan Moonen
Manu L.N.G. Malbrain
Heleen M. Oudemans-van Straaten

References (69)
  1. Reintam A, Parm P, Kitus R, et al. Gastrointestinal symptoms in intensive care patients. Acta Anaesthesiol Scand. 2009; 53(3): 318–324.
  2. Fennessy G, Warrillow S. Gastrointestinal problems in intensive care. Anaesthesia & Intensive Care Medicine. 2012; 13(4): 152–157.
  3. Chaudhry R, Zaki J, Wegner R, et al. Gastrointestinal Complications After Cardiac Surgery: A Nationwide Population-Based Analysis of Morbidity and Mortality Predictors. J Cardiothorac Vasc Anesth. 2017; 31(4): 1268–1274.
  4. Reintam Blaser A, Jakob SM, Starkopf J. Gastrointestinal failure in the ICU. Curr Opin Crit Care. 2016; 22(2): 128–141.
  5. Reintam Blaser A, Poeze M, Malbrain ML, et al. Gastro-Intestinal Failure Trial Group. Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study. Intensive Care Med. 2013; 39(5): 899–909.
  6. Reintam A, Parm P, Kitus R, et al. Gastrointestinal failure score in critically ill patients: a prospective observational study. Crit Care. 2008; 12(4): R90.
  7. Reintam A, Parm P, Redlich U, et al. Gastrointestinal failure in intensive care: a retrospective clinical study in three different intensive care units in Germany and Estonia. BMC Gastroenterol. 2006; 6: 19.
  8. Reintam Blaser A, Malbrain ML, Starkopf J, et al. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Med. 2012; 38(3): 384–394.
  9. Horn CC, Wallisch WJ, Homanics GE, et al. Pathophysiological and neurochemical mechanisms of postoperative nausea and vomiting. Eur J Pharmacol. 2014; 722: 55–66.
  10. Griffiths JD, Gyte GML, Paranjothy S, et al. Interventions for preventing nausea and vomiting in women undergoing regional anaesthesia for caesarean section. Cochrane Database Syst Rev. 2012(9): CD007579.
  11. Apfel CC, Turan A, Souza K, et al. Intravenous acetaminophen reduces postoperative nausea and vomiting: a systematic review and meta-analysis. Pain. 2013; 154(5): 677–689.
  12. Carlisle JB, Stevenson CA. Drugs for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev. 2006(3): CD004125.
  13. PONV Prophylaxis Guidelines. Stanford Medical School. . http://ether.stanford.edu/policies/PONV_prophylaxis_guidelines.html (15.09.2017).
  14. Rae A. Reasons for delayed patient discharge following day surgery: a literature review. Nurs Stand. 2016; 31(11): 42–51.
  15. Latz B, Mordhorst C, Kerz T, et al. Postoperative nausea and vomiting in patients after craniotomy: incidence and risk factors. J Neurosurg. 2011; 114(2): 491–496.
  16. Kranke P, Eberhart LHJ. Possibilities and limitations in the pharmacological management of postoperative nausea and vomiting. Eur J Anaesthesiol. 2011; 28(11): 758–765.
  17. Sheen MJ, Chang FL, Ho ST. Anesthetic premedication: new horizons of an old practice. Acta Anaesthesiol Taiwan. 2014; 52(3): 134–142.
  18. Bouvet L, Mazoit JX, Chassard D, et al. Clinical assessment of the ultrasonographic measurement of antral area for estimating preoperative gastric content and volume. Anesthesiology. 2011; 114(5): 1086–1092.
  19. Hasler WL. Gastroparesis--current concepts and considerations. Medscape J Med. 2008; 10(1): 16.
  20. Reintam Blaser A, Starkopf J, Alhazzani W, et al. ESICM Working Group on Gastrointestinal Function. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med. 2017; 43(3): 380–398.
  21. Reignier J, Mercier E, Le Gouge A, et al. Clinical Research in Intensive Care and Sepsis (CRICS) Group. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA. 2013; 309(3): 249–256.
  22. Rice TW. Gastric residual volume: end of an era. JAMA. 2013; 309(3): 283–284.
  23. Taylor BE, McClave SA, Martindale RG, et al. Society of Critical Care Medicine, American Society of Parenteral and Enteral Nutrition. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Crit Care Med. 2016; 44(2): 390–438.
  24. De Keulenaer BL, De Backer A, Schepens DR, et al. Abdominal compartment syndrome related to noninvasive ventilation. Intensive Care Med. 2003; 29(7): 1177–1181.
  25. Vather R, O'Grady G, Bissett IP, et al. Postoperative ileus: mechanisms and future directions for research. Clin Exp Pharmacol Physiol. 2014; 41(5): 358–370.
  26. Uray KS, Laine GA, Xue H, et al. Intestinal edema decreases intestinal contractile activity via decreased myosin light chain phosphorylation. Crit Care Med. 2006; 34(10): 2630–2637.
  27. van der Spoel JI, Oudemans-van Straaten HM, Stoutenbeek CP, et al. Neostigmine resolves critical illness-related colonic ileus in intensive care patients with multiple organ failure ― a prospective, double-blind, placebo-controlled trial. Intensive Care Med. 2001; 27(5): 822–827.
  28. van der Spoel JI, Schultz MJ, van der Voort PHJ, et al. Influence of severity of illness, medication and selective decontamination on defecation. Intensive Care Med. 2006; 32(6): 875–880.
  29. van der Spoel JI, Oudemans-van Straaten HM, Kuiper MA, et al. Laxation of critically ill patients with lactulose or polyethylene glycol: a two-center randomized, double-blind, placebo-controlled trial. Crit Care Med. 2007; 35(12): 2726–2731.
  30. Saunders MD, Kimmey MB. Systematic review: acute colonic pseudo-obstruction. Aliment Pharmacol Ther. 2005; 22(10): 917–925.
  31. Fernandes T, Oliveira MI, Castro R, et al. Bowel wall thickening at CT: simplifying the diagnosis. Insights Imaging. 2014; 5(2): 195–208.
  32. Nessim C, Sidéris L, Turcotte S, et al. The effect of fluid overload in the presence of an epidural on the strength of colonic anastomoses. J Surg Res. 2013; 183(2): 567–573.
  33. Reintam Blaser A, Deane AM, Fruhwald S. Diarrhoea in the critically ill. Curr Opin Crit Care. 2015; 21(2): 142–153.
  34. Shaikh N, Kettern MA, Hanssens Y, et al. A rare and unsuspected complication of Clostridium difficile infection. Intensive Care Med. 2008; 34(5): 963–966.
  35. Kirkpatrick AW, Roberts DJ, De Waele J, et al. Pediatric Guidelines Sub-Committee for the World Society of the Abdominal Compartment Syndrome. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013; 39(7): 1190–1206.
  36. Iyer D, Rastogi P, Åneman A, et al. Early screening to identify patients at risk of developing intra-abdominal hypertension and abdominal compartment syndrome. Acta Anaesthesiol Scand. 2014; 58(10): 1267–1275.
  37. Holodinsky JK, Roberts DJ, Ball CG, et al. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis. Crit Care. 2013; 17(5): R249.
  38. Reintam Blaser A, Blaser AR, Parm P, et al. Risk factors for intra-abdominal hypertension in mechanically ventilated patients. Acta Anaesthesiol Scand. 2011; 55(5): 607–614.
  39. Malbrain ML, Chiumello D, Pelosi P, et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med. 2005; 33(2): 315–322.
  40. Malbrain ML, Chiumello D, Pelosi P, et al. Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med. 2004; 30(5): 822–829.
  41. Malbrain ML, Peeters Y, Wise R. The neglected role of abdominal compliance in organ-organ interactions. Crit Care. 2016; 20: 67.
  42. Blaser AR, Björck M, De Keulenaer B, et al. Abdominal compliance: A bench-to-bedside review. J Trauma Acute Care Surg. 2015; 78(5): 1044–1053.
  43. Ho LM, Paulson EK, Thompson WM. Pneumatosis intestinalis in the adult: benign to life-threatening causes. AJR Am J Roentgenol. 2007; 188(6): 1604–1613.
  44. Becquemin JP, Majewski M, Fermani N, et al. Colon ischemia following abdominal aortic aneurysm repair in the era of endovascular abdominal aortic repair. J Vasc Surg. 2008; 47(2): 258–63; discussion 263.
  45. Baker ML, Williams RN, Nightingale JMD. Causes and management of a high-output stoma. Colorectal Dis. 2011; 13(2): 191–197.
  46. Arenas Villafranca JJ, López-Rodríguez C, Abilés J, et al. Protocol for the detection and nutritional management of high-output stomas. Nutr J. 2015; 14: 45.
  47. Holzheimer RG, Mannick JA, editors. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich: Zuckschwerdt; 2001. https://www.ncbi.nlm.nih.gov/books/NBK6880/.
  48. Thibault R, Picot D. Chyme reinfusion or enteroclysis in nutrition of patients with temporary double enterostomy or enterocutaneous fistula. Curr Opin Clin Nutr Metab Care. 2016 [Epub ahead of print].
  49. Pironi L. Definitions of intestinal failure and the short bowel syndrome. Best Pract Res Clin Gastroenterol. 2016; 30(2): 173–185.
  50. Klek S, Forbes A, Gabe S, et al. Management of acute intestinal failure: A position paper from the European Society for Clinical Nutrition and Metabolism (ESPEN) Special Interest Group. Clin Nutr. 2016; 35(6): 1209–1218.
  51. Ishii M, Mizuguchi T, Harada K, et al. Comprehensive review of post-liver resection surgical complications and a new universal classification and grading system. World J Hepatol. 2014; 6(10): 745–751.
  52. Bates E, Martin D. Immediate postoperative management and complications on the intensive care unit. Br J Hosp Med (Lond). 2017; 78(5): 273–277.
  53. Hadjihambi A, Khetan V, Jalan R. Pharmacotherapy for hyperammonemia. Expert Opin Pharmacother. 2014; 15(12): 1685–1695.
  54. Ryan JM, Tranah T, Mitry RR, et al. Acute liver failure and the brain: a look through the crystal ball. Metab Brain Dis. 2013; 28(1): 7–10.
  55. Wijdicks EFM, Wijdicks EFM. Hepatic Encephalopathy. N Engl J Med. 2016; 375(17): 1660–1670.
  56. Wang S, Ma L, Zhuang Y, et al. Screening and risk factors of exocrine pancreatic insufficiency in critically ill adult patients receiving enteral nutrition. Crit Care. 2013; 17(4): R171.
  57. Bassi C, Dervenis C, Butturini G, et al. International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005; 138(1): 8–13.
  58. Shah N, Hamilton M. Clinical review: Can we predict which patients are at risk of complications following surgery? Crit Care. 2013; 17(3): 226.
  59. Fruhwald S, Holzer P, Metzler H. Gastrointestinal motility in acute illness. Wien Klin Wochenschr. 2008; 120(1-2): 6–17.
  60. Gutermann IK, Niggemeier V, Zimmerli LU, et al. Gastrointestinal bleeding and anticoagulant or antiplatelet drugs: systematic search for clinical practice guidelines. Medicine (Baltimore). 2015; 94(1): e377.
  61. Sobieraj DM, Coleman CI, Tongbram V, et al. Comparative effectiveness of low-molecular-weight heparins versus other anticoagulants in major orthopedic surgery: a systematic review and meta-analysis. Pharmacotherapy. 2012; 32(9): 799–808.
  62. Lee SY, Cheon HJ, Kim SJ, et al. Clinical predictors of aspiration after esophagectomy in esophageal cancer patients. Support Care Cancer. 2016; 24(1): 295–299.
  63. Park JS, Huh JW, Park YAh, et al. Risk Factors of Anastomotic Leakage and Long-Term Survival After Colorectal Surgery. Medicine (Baltimore). 2016; 95(8): e2890.
  64. Zacharias A, Schwann TA, Parenteau GL, et al. Predictors of gastrointestinal complications in cardiac surgery. Tex Heart Inst J. 2000; 27(2): 93–99.
  65. Andersson B, Andersson R, Brandt J, et al. Gastrointestinal complications after cardiac surgery - improved risk stratification using a new scoring model. Interact Cardiovasc Thorac Surg. 2010; 10(3): 366–370.
  66. Preiser JC, van Zanten ARH, Berger MM, et al. Metabolic and nutritional support of critically ill patients: consensus and controversies. Crit Care. 2015; 19: 35.
  67. Braunschweig CA, Sheean PM, Peterson SJ, et al. Intensive nutrition in acute lung injury: a clinical trial (INTACT). JPEN J Parenter Enteral Nutr. 2015; 39(1): 13–20.
  68. Elke G, van Zanten ARH, Lemieux M, et al. Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Crit Care. 2016; 20(1): 117.
  69. Fraipont V, Preiser JC. Energy estimation and measurement in critically ill patients. JPEN J Parenter Enteral Nutr. 2013; 37(6): 705–713.

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