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Constipation en réanimation : physiopathologie, définition, valeur pronostique, prise en charge

Constipation in intensive care unit: Pathophysiology, definition, prognostic value, and management

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Réanimation

Résumé

Les symptômes gastro-intestinaux sont fréquents et variés chez les patients de réanimation. La physiopathologie de la motricité digestive est complexe et influencée par les agressions habituellement identifiées chez des patients de réanimation, mais aussi par différentes thérapeutiques. La définition de la constipation est variable du fait de critères diagnostiques différents dans les études et d’une estimation difficile liée au contexte. Cela participe à la variabilité de l’incidence rapportée de ce trouble. La valeur pronostique est également sujette à débats, et il reste impossible de déterminer avec exactitude si la constipation est une entité morbide à part entière ou un reflet de la sévérité des patients qui en souffrent. De nombreux travaux retrouvent cependant une influence de la constipation sur la durée de ventilation mécanique et la durée de séjour en réanimation. La prise en charge n’est pas codifiée, et l’identification du mécanisme physiopathologique pourrait avoir un intérêt dans l’efficacité du traitement, dont la nature, le délai d’initiation et les objectifs thérapeutiques restent à définir précisément.

Abstract

Gastrointestinal symptoms are frequently experienced by intensive care unit (ICU) patients. The pathophysiology of gut motility is complex and influenced by usual ICU injuries or therapeutics. Definition of constipation remains different among studies because of lack of homogeneous definition criteria. The estimation is also more difficult in the ICU setting. This may partly explain the differences in reported incidence in previous works on the field. Prognostic value of constipation is also a matter of debate and it is still impossible to state whether constipation is an autonomous morbid disease or a surrogate of patient’s severity. Nevertheless, many works have evidenced an association between constipation and length of mechanical ventilation and length of stay in ICU. There is no consensus on management and the identification of the pathophysiological mechanisms may guide the therapeutic. The specific drugs to use as well as the timing of ignition and therapeutic goals remain to be defined.

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Références

  1. Fruhwald S, Holzer P, Metzler H (2007) Intestinal motility disturbances in intensive care patients pathogenesis and clinical impact. Intensive Care Med 33:36–44

    Article  PubMed  Google Scholar 

  2. Reintam A, Parm P, Kitus R, et al (2009) Gastrointestinal symptoms in intensive care patients. Acta Anaesthesiol Scand 53:318–24

    Article  CAS  PubMed  Google Scholar 

  3. Reintam Blaser A, Malbrain ML, Starkopf J, et al (2012) Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Med 38:384–94

    Google Scholar 

  4. Mutlu GM, Mutlu EA, Factor P (2001) GI complications in patients receiving mechanical ventilation. Chest 119:1222–41

    Article  CAS  PubMed  Google Scholar 

  5. Reintam A, Parm P, Kitus R, et al (2013) Gastrointestinal symptoms in intensive care patients. Acta Anesthesiol Scand 53:318–24

    Article  Google Scholar 

  6. American Gastroenterological Association, Bharucha AE, Dorn SD, et al (2013) American Gastroenterological Association medical position statement on constipation. Gastroenterology 144:211–7

    Article  Google Scholar 

  7. Lembo A, Camilleri M (2003) Chronic constipation. N Engl J Med 349:1360–8

    Article  CAS  PubMed  Google Scholar 

  8. Drossman DA, Corazziari E, Delvaux M, et al (2006) Rome III: the functional gastrointestinal disorders. Degnon Associates, McLean, Virginia

  9. Nassar AP Jr, Queiroz da Silva FM, de Cleva R (2009) Constipation in intensive care unit: incidence and risk factors. J Crit Care 24:630e9–630e12

    Article  Google Scholar 

  10. Guerra TL, Mendonça SS, Marshall NG (2013) Incidence of constipation in an intensive care unit. Rev Bras Ter Intensiva 25:87–92

    Article  PubMed  Google Scholar 

  11. Trexler ST, Lundry JB, Chung KK, et al (2014) Prevalence and impact of late defecation in the critically ill, thermally injured adult patient. J Burn Care Res 35:224–9

    Article  Google Scholar 

  12. Gacouin A, Camus C, Gros A, et al (2010) Constipation in longterm ventilated patients: associated factors and impact on the outcome. Crit Care Med 38:1933–8.

    Article  PubMed  Google Scholar 

  13. Mostafa SM, Bhandari S, Ritchie G, et al (2003) Constipation and its implications in the critically ill patient. Br J Anaesth 91:815–9

    Article  CAS  PubMed  Google Scholar 

  14. van der Spoel JI, Schultz MJ, van der Voort PH, et al (2006) Influence of severity of illness, medication and selective tract decontamination. Intensive Care Med 32:875–80

    Article  PubMed  Google Scholar 

  15. Savoye G, Hommel S, Lerebours E (2009) Fonctions du grêle et du côlon. Traité de réanimation médicale. Masson, pp 178–84

    Google Scholar 

  16. Dive A (2001) L’administration de prokinétiques au cours d’une alimentation entérale: utilité et limites. Réanimation 10:562–9

    Article  Google Scholar 

  17. Prat D, Messika J, Avenel A, et al (2012) Incidence, facteurs de risque et valeur pronostique de la constipation en réanimation: résultats préliminaires d’une étude prospective. Réanimation 22: SP174

    Google Scholar 

  18. Montejo JC (1999) Enteral nutrition-related gastrointestinal complications in critically ill patients: a multicenter study. The Nutritional and Metabolic Working Group of the Spanish Society of Intensive Care Medicine and Coronary Units. Crit Care Med 27:1447–53

    CAS  Google Scholar 

  19. Piche T, Dapoigny M, Bouteloup C, et al (2007) Recommendations for the clinical management and treatment of chronic constipation in adults. Gastroenterol Clin Biol 31:125–35

    Article  Google Scholar 

  20. Heaton KW, Radvan J, Cripps H, et al (1992) Defecation frequency and timing, and stool form in the general population: a prospective study. Gut 33:818–24

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Nguyen T, Frenette AJ, Johanson C, et al (2013) Impaired gastrointestinal transit and its associated morbidity in the intensive care unit. J Crit Care 537:e11–e7

    Google Scholar 

  22. van der Spoel JL, Oudemans-van Straaten HM, Stoutenbeek CP, et al (2001) 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 27:822–7

    Article  CAS  PubMed  Google Scholar 

  23. van der Spoel JL, Oudemans-van Staaten HM, Kuiper MA, et al (2007) Laxation of critically ill patients with lactulose or polyethylene glycol: a two-center randomized, double-blind, placebocontrolled trial. Crit Care Med 35: 2726–31

    Article  CAS  PubMed  Google Scholar 

  24. Guardiola B, Llompart-Pou JA, Ibáñez J, Raurich JM (2016) Prophylaxis versus treatment use of laxative for paralysis of lower gastrointestinal tract in critically ill patients. J Clin Gastroenterol 50:e13–e8

    Article  PubMed  Google Scholar 

  25. Masri Y, Abubaker J, Ahmed R (2010) Prophylactic use of laxative for constipation in critically ill patients. Ann Thor Med 5:228–31

    Article  Google Scholar 

  26. Patanwala AE, Abarca J, Huckleberry Y, Erstad BL (2006) Pharmacologic management of constipation in the critically ill patient. Pharmacotherapy 26:896–902

    Article  CAS  PubMed  Google Scholar 

  27. de Azevedo RP, Freitas FG, Ferreira EM, et al (2015) Daily laxative therapy reduces organ dysfunction in mechanically ventilated patients: a phase II randomized controlled trial. Crit Care 19:s329

    Article  Google Scholar 

  28. Prat D, Messika J, Avenel A, et al (2016) Constipation incidence and impact in medical care patients: importance of the definition criterion. Eur J Gastroenterol hepatol 28:290–6

    Article  CAS  PubMed  Google Scholar 

  29. Knowles S, McInnes E, Elliott D, et al (2014) Evaluation of the implementation of a bowel management protocol in intensive care: effect on clinician practices and patient outcomes. J Clin Nurs 23:716–30

    Article  PubMed  Google Scholar 

  30. Ely EW, Inouye SK, Bernard GR (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM–ICU). JAMA 286:2703–10

    Article  CAS  PubMed  Google Scholar 

  31. Smonig R, Wallenhorst T, Bouju P, et al (2016) Constipation is independently associated with delirium in critically ill ventilated patients. Intensive Care Med 42:126–7

    Article  PubMed  Google Scholar 

  32. Mayer A (2011) Gut feelings: the emerging biology of gut-brain communications. Nat Rev Neurosci 12:453–66

    Article  CAS  PubMed  Google Scholar 

  33. Gibson CM, Pass SE (2014) Enteral naloxone for the treatment of opioid-induced constipation in the medical intensive care unit. J Crit Care 29:803–7

    Article  CAS  PubMed  Google Scholar 

  34. Meissner W, Schmidt U, Hartmann M, et al (2000) Oral naloxone reverses opioid-associated constipation. Pain 84:105–9

    Article  CAS  PubMed  Google Scholar 

  35. Leppert W (2015) Emerging therapies for patients with symptoms of opioid-induced bowel dysfunction. Drug Des Devel Ther 9:2215–31

    Article  PubMed  PubMed Central  Google Scholar 

  36. Wald A (2016) Constipation: advances in diagnosis and treatment. JAMA 315:185–91

    CAS  PubMed  Google Scholar 

  37. Piton G, Manzon C, Cypriani B, et al (2011) Acute intestinal failure in critically ill patients: is plasma citrulline the right marker? Intensive Care Med 37:911–7

    Article  PubMed  Google Scholar 

  38. Hittaka H, Akimoto H, Takeshita H, et al (2014) Usefulness of intestinal fatty acid-binding protein in predicting strangulated small bowel obstruction. PLoS One 9:e99915

    Article  Google Scholar 

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Authors and Affiliations

  1. Service de réanimation polyvalente, hôpital Antoine-Béclère, Assistance publique–Hôpitaux de Paris (AP–HP), université Paris-Sud, 157, rue de la-Porte-de-Trivaux, F-92140, Clamart, France

    D. Prat & B. Sztrymf

  2. Service de réanimation médicochirurgicale, Assistance publique–Hôpitaux de Paris, hôpital Louis-Mourier, F-92700, Colombes, France

    J. Messika, M. Le Meur & J.-D. Ricard

  3. Institut national de la santé et de la recherche médicale, Inserm, IAME 1137, F-75018, Paris, France

    J. Messika & J.-D. Ricard

  4. Université Paris-Diderot, IAME 1137, Sorbonne–Paris-Cité, F-75018, Paris, France

    J. Messika & J.-D. Ricard

  5. Institut national de la santé et de la recherche médicale, Inserm U999, F-92060, Le Plessis-Robinson, France

    B. Sztrymf

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  1. D. Prat
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  2. J. Messika
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Correspondence to B. Sztrymf.

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Prat, D., Messika, J., Le Meur, M. et al. Constipation en réanimation : physiopathologie, définition, valeur pronostique, prise en charge. Réanimation 25, 372–381 (2016). https://doi.org/10.1007/s13546-016-1203-6

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  • DOI: https://doi.org/10.1007/s13546-016-1203-6

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